再手术机器人三尖瓣手术的安全性和疗效

IF 1.6 Q2 SURGERY
Panos N Vardas, Brock Daughtry, James Lee West, Rongbing Xie, Gagandip Singh, Lamario Williams, James Davies, Clifton Lewis
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引用次数: 0

摘要

目的:孤立性三尖瓣(TV)病变的再手术与高发病率和高死亡率有关;然而,目前的指南建议对重度、无症状的 TV 反流或伴有进行性右心室功能障碍的轻度至中度症状进行干预。有关 TV 疾病再手术干预的数据极少。同样,也没有大规模的系列研究描述机器人辅助的TV再手术:利用胸外科医师协会成人心脏外科数据库的机构数据,确定了 2 家三级转诊医院在 2017 年至 2022 年期间接受机器人辅助 TV 手术的既往心脏手术患者。对患者人口统计学、术前特征、疾病进展、手术细节和结果进行了分析。主要结果是 30 天死亡率。次要结果为 30 天再入院率、住院时间和不良事件。描述性和总结性统计用于描述临床数据,并通过双变量分析研究原发性病因与继发性病因患者的预后差异:24名患者被分为两组,一组是原发性电视病变,另一组是合并心脏病导致的继发性功能障碍。总死亡率为 8.3%。主要并发症包括呼吸衰竭、肾功能衰竭和再次手术的比例分别为12.5%、8.3%和8.3%。没有人需要永久起搏器,30天再入院率为4.5%:对于原发性和继发性TV病变,机器人TV再手术是传统胸骨切开术的一种安全可行的替代方案。使用微创技术可以进行 TV 修复和置换。与传统方法相比,微创方法的发病率和死亡率都是可以接受的,而且对起搏器安置的需求也有所减少。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Safety and Outcomes of Reoperative Robotic Tricuspid Valve Surgery.

Objective: Reoperative surgery for isolated tricuspid valve (TV) pathology has been associated with high morbidity and mortality rates; however, the current guidelines recommend intervention for severe, symptomatic TV regurgitation or mild to moderate symptoms with progressive right ventricular dysfunction. There are minimal data regarding reoperative intervention for TV disease. Similarly, there are no large series describing robot-assisted reoperative TV surgery.

Methods: Institutional Society of Thoracic Surgeons Adult Cardiac Surgery Database data were used to identify patients with previous cardiac surgery undergoing robot-assisted TV surgery from 2017 to 2022 from 2 tertiary referral hospitals. Patient demographics, preoperative characteristics, disease progression, operative details, and outcomes were analyzed. The primary outcome was 30-day mortality. Secondary outcomes were 30-day readmission, length of stay, and adverse events. Descriptive and summative statistics were used to describe clinical data and examine differences in outcomes of patients with primary versus secondary etiology using bivariate analyses.

Results: Twenty-four patients were divided into 2 arms, primary TV pathology and secondary dysfunction due to comorbid cardiac conditions. The overall mortality was 8.3%. Major complications, including respiratory failure, renal failure, and reoperation were 12.5%, 8.3%, and 8.3%, respectively. No permanent pacemakers were required, and the 30-day readmission rate was 4.5%.

Conclusions: Reoperative robotic TV surgery is a safe and viable alternative to traditional sternotomy for both primary and secondary TV pathology. TV repair and replacement are possible using the minimally invasive technique. The morbidity and mortality rates are acceptable when compared with traditional approaches with decreased need for pacemaker placement in the minimally invasive approach.

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来源期刊
CiteScore
2.00
自引率
6.70%
发文量
80
期刊介绍: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery is the first journal whose main mission is to disseminate information specifically about advances in technology and techniques that lead to less invasive treatment of cardiothoracic and vascular disease. It delivers cutting edge original research, reviews, essays, case reports, and editorials from the pioneers and experts in the field of minimally invasive cardiothoracic and vascular disease, including biomedical engineers. Also included are papers presented at the annual ISMICS meeting. Official Journal of the International Society for Minimally Invasive Cardiothoracic Surgery
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