Application of lower median ministernotomy in heart surgery / 中国微创外科杂志

ABSTRACT

Objective To review the experience of 460 cases of cardiac operations through a lower median ministernotomy. Methods A total of 460 cardiac operations via a lower median ministernotomy route were carried out between January 1997 and August 2003 in this hospital, involving 100 operations for congenital heart diseases, 178 valve operations, 168 coronary operations, 12 operations for aneurysms, and 2 other operations. On operation no special instruments were required. Results Within the hospitalization period 4 patients died (0.9%) and 3 underwent a re-operation (0.7%). Postoperative complications occurred in 29 patients (6.3%). Off-pump operations were employed in 73 patients, while in the remaining 387 patients the cardiopulmonary bypass time was 25~1 115 min (median, 80 min) and the aortic cross-clamp time was 0~164 min (55.8?31.9 min). Of the 460 patients, the length of postoperative tracheal intubation was 0~364 h (median, 10 h), and the postoperative chest drainage was 20~3 290 ml (median, 350 ml), or 0.3~42.2 ml/kg (median, 5.8 ml/kg). Blood transfusion were required after surgery in 280 patients with an amount of 951.1?644.6 ml. The postoperative ICU and hospital stay were 1~28 d (median, 2 d) and 1~60 d (11.6?6.0 d), respectively. A follow-up for 7~80 months (59.2?29.6 months) in 371 patients was conducted. No long-term deaths were noted and symptoms were significantly improved. Heart function was classified as grade Ⅰ in 169 patients, grade Ⅱ in 135 patients, and grade Ⅲ in 67 patients, respectively, with significant difference as compared with that in pre-operation ( Z =-12.57 , P =0.000). No significant difference was observed in the cardiothoracic ratio (0.50?0.11, 0.41~0.67) between postoperative and preoperative period ( t =-1.63, P =0.104). The left ventricular ejection fraction was significantly higher postoperatively (0.36~0.71, 0.606?0.113) than preoperatively ( t =3.43, P =0.001). Conclusions In properly selected cases, heart operations through a lower median ministernotomy provides many advantages including mini-invasion, high reliability, excellent cosmetic results, simplicity to performance, and good surgical outcomes.