Objectives

Minimally invasive valve surgery has become increasingly accepted as an alternative to conventional median sternotomy in low-risk patients. However, there have been no reports regarding the outcomes of this procedure on high-risk hemodialysis patients. The purpose of this investigation was to assess the surgical outcomes of minimally invasive aortic valve replacement (AVR) via right mini-thoracotomy (MIAVR) in hemodialysis patients compared with those of conventional AVR (CAVR) via full sternotomy.

Methods

Two hundred and seventy-four patients underwent isolated AVR for severe AS, and 42 hemodialysis patients were included in this study. MIAVR was performed in 17 cases and CAVR in 25 cases. We compared the short-term surgical outcome among the two groups.

Results

There was no difference in the aortic cross-clamp or cardiopulmonary bypass time. However, the procedure time was significantly shorter in the MIAVR group. Patients in the MIAVR group had less bleeding and a smaller amount of transfused red blood cells. There were four hospital deaths (18.2%) in the CAVR group. For postoperative complications, there were 2 (9.1%) cerebrovascular incidents, 2 (9.1%) cases of respiratory failure, 1 (4.5%) re-exploration for bleeding in CAVR group. The postoperative ventilation time was significantly shorter in the MIAVR group. There was no difference in the length of postoperative intensive care unit stay or of postoperative hospital stay.

Conclusion

The surgical outcomes of MIAVR in hemodialysis patients were acceptable, with a low incidence of morbidity, reasonable lengths of hospital stay, and no mortality among the patients studied.

中文翻译：

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经右小切口微创主动脉瓣置换术治疗血液透析患者的手术效果

目标

微创瓣膜手术已被越来越多地接受为低风险患者传统正中胸骨切开术的替代方法。然而，尚无关于该程序对高危血液透析患者的结果的报道。本研究的目的是评估血液透析患者通过右侧小切口 (MIAVR) 进行的微创主动脉瓣置换术 (AVR) 与通过全胸骨切开术进行的常规 AVR (CAVR) 的手术结果。

方法

274 名患者因严重 AS 接受了单纯 AVR，其中 42 名血液透析患者被纳入本研究。MIAVR 17 例，CAVR 25 例。我们比较了两组的短期手术结果。

结果

主动脉交叉钳夹或体外循环时间没有差异。然而，MIAVR 组的手术时间明显缩短。MIAVR 组的患者出血较少，输注的红细胞数量较少。CAVR 组有 4 例医院死亡（18.2%）。术后并发症CAVR组脑血管事件2例（9.1%），呼吸衰竭2例（9.1%），出血再探查1例（4.5%）。MIAVR 组术后通气时间明显缩短。术后重症监护病房住院时间或术后住院时间无差异。

结论

MIAVR 在血液透析患者中​​的手术结果是可以接受的，发病率低，住院时间合理，研究的患者中没有死亡率。