Annals of Thoracic Surgery最新文献

Background: Right ventricular (RV) function is frequently reduced following cardiac surgery, with persistent impairment associated with increased mortality. This study aimed to compare RV function following mitral valve repair via right minithoracotomy versus sternotomy.

Methods: In the UK Mini Mitral Trial, patients were randomized to mitral valve repair via right minithoracotomy (small lateral pericardial incision) or sternotomy. Prespecified secondary outcomes included assessment of cardiac function via blinded echocardiography pre-operatively, at early (12 weeks) and late (52 weeks) time points. RV function was assessed via tricuspid annular plane systolic excursion (TAPSE). RV to pulmonary artery coupling was determined by the TAPSE to systolic pulmonary artery pressure ratio.

Results: Of 330 patients randomized, 224 had suitable echocardiographic data for analysis. Baseline demographic, clinical, and echocardiographic data were comparable between groups. Cross-clamp and bypass times were significantly longer in the minithoracotomy group. At 12 weeks, there was a significant reduction in TAPSE from baseline in both groups (TAPSE minithoracotomy -7.52mm, 95% confidence interval (CI) -8.52 - -6.53, P<0.001, versus sternotomy -8.75mm, -9.80 - -7.71, P<0.001), which recovered, however not to pre-operative levels by 52 weeks. The degree of RV impairment was significantly less in the minithoracotomy group at both early (between group difference in TAPSE 1.47mm, 95% CI 0.37 - 2.56, P=0.009) and late time points (1.37mm, 95% CI 0.29 - 2.45, P=0.013).

Conclusions: Despite longer cross-clamp and bypass times, mitral valve repair via minithoracotomy, was superior to sternotomy at preserving RV function (measured by TAPSE), at 12 weeks and one year.

Background: This study gives evaluations of the early-term results of minimally invasive cardiac surgery for definitively treating Tetralogy of Fallot (TOF).

Methods: A study on 46 patients, who were aged ≥ 3 months and suffered TOF, was carried out over a period from May 2023 to May 2024.

Results: All 46 patients (mean age 8.4 months, weight 7.1 ± 1.8 kg) underwent TOF repair via right vertical infra-axillary thoracotomy. Only one patient required re-intervention for electrode wire bleeding, managed through the same incision. Mean cardiopulmonary bypass and aortic clamp times were 174 ± 48 and 108 ± 35 minutes, respectively. Average postoperative hospital stay was 10.3 ± 8.6 days. The most common early complications were postoperative pneumonia (26.1%) and junctional ectopic tachycardia (23.9%). Follow-up was conducted in all patients, with an average duration of 8.1 ± 4.3 months. At the last follow-up, right ventricular outflow tract pressure gradient decreased from 63 ± 23.2 to 20 ± 9.8 mmHg, and pulmonary valve annulus size increased from 8.7 ± 1.9 to 11.6 ± 1.8 mm. No deaths occurred during follow-up. Mild and moderate right ventricular outflow tract stenosis were observed in 22 (47.8%) and 2 (4.2%) patients, respectively. One patient (2.1%) developed moderate pulmonary valve regurgitation.

Conclusions: The early-term result of minimally invasive cardiac surgery in the treatment of TOF is relatively positive, making this a promising alternative to the traditional method. However, further practice in a narrow space is required to reach proficiency.