| 2007年5月17- 20日接受亚洲心脏外科学会主席吴清玉教授邀请，杨传瑞博士主持第15届亚洲心脏外科学会年会微创专题会议，并在会议上报告了采用系列微创器械经腋下小切口成功治疗先心病741例，风心病（瓣膜成形及换瓣）91例，为目前世界上采用该技术临床应用的最大一组病例(832例)报告。该组病人到目前为止，尚无一例病人出现严重手术并发症。手术效果极佳。
以下为该报告的英文摘要
Experience in Correction of Congenital Heart Disease and Valve Replacement of Rheumatic Heart Disease by Minimally Invasive Surgery
( 832 cases report )
(abstract)
Chuan-rui Yang MD. zhang jianqun MD, Bo ping MD, Chao xiangrong MD, Xu yi MD Bai tao MD ,Hang xinsheng MD, Huang guohui MD, Song wei MD, Mu junhsneg MD
Department of Cardiac Surgery , Anzhen Hospital , Capital Medical University, Beijing , China
From July 2000 to September 2006, 741patients with congenital heart disease ( ranging from 2 to 42 years old ) were repaired , and 91 patients with Rheumatic Heart Disease ( ranging from 16 to 57 years ) had mitral valve operation using Right Oblique Infra-Axillary Thoracotomy
Material and method
Medtronic Aortic Cannular
A stab knife for ascending aortic cannulation
Stabilizers for Aortic Cannulation
Stabilizers for Superior Vena Cave cannulation
Retractor for Pericardium Suspension
Minimally Invasive Right Oblique Infra-Axillary Thoracotomy for Congenital Heart Disease：741 Cases
VSD —— 391 cases
VSD + DCRV______________ 7 cases
ASD —— 327 cases
Teralogy of Fallot — 4 cases
PAVCD —— 5 cases
PAPVC —— 7 cases
Minimally Invasive Right Oblique Infra -- Axillary Thoracotomy for Mitral Valve disease, Total: 91 Cases
MVR + TVP —— 51 cases
MVR —— 25 cases
MVP —— 9 cases
Thrombi of left atrium_ _________ 6 cases
SURGICAL TECHNIQUE (1)
Right Oblique Infra-Axillary Thoracotomy
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1.Patient position : Left lateral decubitus 45 degrees
2.The skin incision :From third to fifth intercostal space (5—12 CM)
3.Entering the chest cavity through the fourth or third intercostal
4.Opening the pericardium longitudinally 2 to 3 cm anterior to the phrenic nerve
SURGICAL TECHNIQUE(2)
A series of new operative instruments:
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1. A stab knife for ascending aortic cannulation
2. Medtronic aortic cannular
3. retractor for pericardium suspension
4. A new instrument tool for bicaval snares
5. Stabilizers for all kinds of cannulation
Result (1)
( In Congenital Heart Group )
Skin incision: 5—8cm in children；8 – 12cm over 12-year。
Aortic clamping time 18 – 72minutes
285 of 327 ASD were beating heart surgery ,
CPB time : 16- 82minutes;
Operation time ：58 – 153 minutes
result (2)
( In Congenital Heart Group )
no early or late deaths in this group
Aortic rupture one case
hemorrhage necessitating reexploration 6 cases
paresis of the right hemidiaphragm – one case
rib fractures in 12 patients.
Follow-up ranged from 4 to 72 months (mean 48.8 months) and included 426 of the 741patients. They were all in normal sinus rhythm and free of symptoms, in New York Heart Association functional class I except for one patient who had mild dyspnea with exertion, attributed to right phrenic nerve paralysis in congenital heart group
Result (3)
( In Rheumatic Heart Disease Group )
Skin incision in adult patients:9.6±1.81cm
Aortic clamping time:40.8±23.29minutes。
CPB time ：67.4±32.52 minutes。
Operation time ：130±26.85 minutes。
Result (4)
( In Rheumatic Heart Disease Group )
no early deaths in this group
Aortic bleeding one case
hemorrhage necessitating reexploration one case
paresis of the right hemidiaphragm – one case
rib fractures in four patients.
Follow-up ranged from 5 to 68 months (mean 42.3 nonths) and included 64 of the 91 patients. They were all in New York Heart Association functional class I or II except for one patient who had died 2 months after operation in Rheumatic Heart Disease group
Discussion
Complete median sternotomy is the conventional approach for cardiac operations , but it has the invasive and cosmetic problems, especially in young female patients. Minimally invasive approaches for cardiac operations have recently gained widespread interest. --------- Laks H, Hammond GL. A and Dietl CA, Torres AR.
Traditional surgical dictums, such as “wounds heal from side to side and not end to end” and “always make an incision big enough to assure complete exposure” are gradually yielding to less invasive operations.---- Doty DB. (from LDS Hospital, Salt Lake City, Utah USA in 1998)
According our experience, using A series of new operative instruments for treating Congenital Heart Disease and Valve Replacement of Rheumatic Heart Disease by Minimally Invasive Right Oblique Infra-Axillary Thoracotomy has follouing advantages:
1.Short Incision
2.Operating Time is shortened for Some Patiets
3.Less Pain Postoperation
4.A Few Days for Staying in Hospital
5.Less Incidence for Temponade
Disadvantages: Not Suitable for Some Patients including Congenital Heart Disease combined with left side disease and some Rheumatic Heart Disease.
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