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Minimal invasive Mitralklappenchirurgie

Minimally invasive mitral valve surgery

  • Themenschwerpunkt: Minimal Invasive Herzchirurgie
  • Published:
Acta chirurgica Austriaca Aims and scope Submit manuscript

Zusammenfassung

Grundlagen: Ziel der Studie war die Durchführung videoassistierter minimal invasiver Eingriffe an der Mitralklappe mit dem Port-Access-System über eine rechtslaterale Minithorakotomie. Alternative Operationsverfahren werden diskutiert.

Methodik: Das Port-Access-System ermöglicht über einen in die Aorta ascendens vorgeschobenen Katheter ein endoluminales „Ausklemmen“ der aszendierenden Aorta, die Gabe von antegrader Kardioplegie sowie eine linksventrikuläre Entlastung des Herzens. Die Herz-Lungen-Maschine wird femorofemoral angeschlossen. Der Zugang zur Mitralklappe erfolgt über eine rechtslaterale Mini-Thorakotomie im 4. Interkostalraum (4 bis 5 cm Hautinzision); über 2 Ports werden das 3D-Videoskop sowie ein Vorhofhaken eingebracht. Insgesamt wurde bei 75 Patienten mit nichtischämischer Mitralklappenerkrankung ein Klappenersatz bzw. eine Klappenrekonstruktion durchgeführt.

Ergebnisse: Die Dauer der Operation, der extrakorporalen Zirkulation und die Ischämiezeit betrugen 180 ± 51 min, 124 ± 46, und 65 ± 26 min. Die mediane Intubationsdauer betrug 19 h (5 bis 264 h), die Intensivbehandlungsdauer 2 Tage (1 bis 36 Tage) und die Hospitalisierungsdauer 12 Tage (6 bis 36 Tage). Die Mortalität betrug 8%. Bei einer nicht unerheblichen Gesamtmorbidität waren besonders 2 Aortendissektionen unmittelbar operationstechnisch bedingt. Nach einem mittleren Follow-up von 388 ± 29 Tagen war bei 4 Patienten eine Re-Operation aufgrund eines paravalvulären Lecks erforderlich.

Schlußfolgerungen: Mit dem Port-Access-System kann ein kosmetisch günstiges Operationsergebnis mit einer vertretbaren Operationsdauer videoassistiert erzielt werden. Aufgrund der erheblichen Morbidität sowie einer ausgeprägten „learning curve“ sollte die neue Operationstechnik bis zur Ausreifung der Technologie zunächst noch auf einige ausgewählte Zentren beschränkt bleiben.

Summary

Background: Aim of the study was the evaluation of videoassisted minimally invasive mitral valve surgery using the port-access technique via a right lateral mini-thoracotomy. Alternative techniques are discussed.

Methods: The port-access system enables endoluminal aortic clamping, delivery of antegrade cardioplegia and decompression of the left ventricle by means of a triple lumen endoaortic balloon catheter. Femoro-femoral cardiopulmonary bypass is used. The mitral valve is exposed via a small right lateral minithoracotomy in the 4th intercostal space (4 to 5 cm skin incision). A 3D-videoscope and a left atrial retractor are inserted through 2 separate ports. The technique was applied in 75 patients with nonischemic mitral valve disease undergoing mitral valve replacement or repair.

Results: Operation time, cardiopulmonary bypass time and clamp-time were 180 ± 51 min, 124 ± 46, and 65 ± 26 min respectively. Median intubation time was 19 h (5 to 264 h), duration of intensive care treatment and hospitalization were 2 days (1 to 36 days) and 12 days (6 to 36 days) respectively. Hospital mortality was 8%. Overall morbidity was high with 2 aortic dissections being related to the technique used. After a mean follow-up of 388 ± 29 days 4 patients required reoperation for paravalvular leakage.

Conclusions: Using the port-access technique videoassisted minimally invasive mitral valve surgery can be performed with acceptable operating times and a favourable cosmetic result. However, there is a significant learning curve and a high morbidity associated with the procedure. Performance of the new technique should therefore be limited to few centers until more favourable results can be achieved.

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Authors and Affiliations

  1. Aus der Klinik für Herzchirurgie, Herzzentrum, Universität Leipzig, Deutschland

    V. Falk, T. Walther, R. Autschbach, J. A. M. van Son, M. Friedrich, A. Diegeler, R. Battellini & F. W. Mohr

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  1. V. Falk
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  2. T. Walther
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  3. R. Autschbach
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  4. J. A. M. van Son
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  5. M. Friedrich
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  6. A. Diegeler
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  7. R. Battellini
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  8. F. W. Mohr
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Correspondence to V. Falk.

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Falk, V., Walther, T., Autschbach, R. et al. Minimal invasive Mitralklappenchirurgie. Acta Chir Austriaca 30, 25–28 (1998). https://doi.org/10.1007/BF02619846

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  • DOI: https://doi.org/10.1007/BF02619846

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