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微创二尖瓣修复手术后十年：长期预后
A Decade of Minimally Invasive Mitral Repair: Long-Term Outcomes
Galloway AC, Schwartz CF, Ribakove GH  2010/1/13 11:12:35 
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Ann Thorac Surg, 2009,
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Background:
Short-term results with minimally invasive approaches for mitral valve repair in degenerative disease have been encouraging, with potential for diminishing blood loss and hospital length of stay. Little is known, however, about the long-term efficacy of this approach. This report analyzes a single institution's results over 12 years with minimally invasive mitral repair.

Methods:
Since 1986, 3,057 patients have undergone mitral valve repair; 1,601 patients had degenerative disease and are the subject of this report. Minimally invasive mitral repair was done in 1071 patients with a right anterior minithoracotomy and direct vision. Clinical and echocardiographic variables were entered prospectively into a database.

Results:
Hospital mortality was 2.2% for all patients (36 of 1601); 1.3% for isolated minimally invasive (9 of 712) and 1.3% (3 of 223) for isolated sternotomy mitral valve repair; and 3.6% (24 of 666) for valve repair plus a concomitant cardiac procedure. For isolated valve repair, 8-year freedom from reoperation was 91%±2% for sternotomy and 95%±1% for minimally invasive (p=0.24), and 8-year freedom from reoperation or severe recurrent insufficiency was 90%±2% for sternotomy and 93%±1% for minimally invasive (p=0.30). Eight-year freedom from all valve-related complications was 86%±3% for sternotomy and 90%±2% for minimally invasive (p=0.14).

Conclusions:
These data indicate that long-term outcomes after minimally invasive mitral repair are excellent and equivalent to results achieved with sternotomy. In view of previously published advantages of short-term morbidity, minimally invasive approaches to mitral valve surgery deserve expanded use.
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病例分析 <span class="ModTitle_Intro_Right" id="EPMI_Home_MedicalCases_Intro_div" onclick="javascript:window.location='http://portal.elseviermed.cn/tabid/127/Default.aspx'" onmouseover="javascript:document.getElementById('EPMI_Home_MedicalCases_Intro_div').style.cursor='pointer';document.getElementById('EPMI_Home_MedicalCases_Intro_div').style.textDecoration='underline';" onmouseout="javascript:document.getElementById('EPMI_Home_MedicalCases_Intro_div').style.textDecoration='none';">[栏目介绍]</span>  病例分析 [栏目介绍]
室性心动过速多次发作
摘自：《西氏内科学》，第23版
 
患者男性，29岁，因室性心动过速多次发作入院，待行心脏电复律。患者平素体健，自诉于大约5个月前，出现气短、心悸、胸痛的急性发作，并有胸闷感。患者因心电图提示单形性室性心动过速到急诊科就诊。采用胺碘酮行药物复律后无效，但心电图恢复窦性心律。
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