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1.
Zhonghua Yi Xue Za Zhi ; 100(3): 192-196, 2020 Jan 21.
Artigo em Chinês | MEDLINE | ID: mdl-32008285

RESUMO

Objectives: To evaluate the effect of minimally invasive lateral lumbar interbody fusion (LLIF/OLIF) on the sagittal balance of adult degenerative scoliosis. Methods: From January 2014 to June 2017, a total of 23 patients with degenerative scoliosis underwent staged minimally invasive surgery in Shanghai Ruijin Hospital. All patients were implanted with LLIF or OLIF cage from the lateral approach first, and was followed by the posterior percutaneous pedicle screw fixation or pedicle screw fixation via Wiltse approach. If the sagittal deformity correction was not satisfactory after the first surgery, a posterior osteotomy can be performed during the second stage operation. A biplanar X-ray of the whole spine was taken with the EOS imaging system before and after surgery. The EOS software was used to measure and evaluate the patient's sagittal balance parameters including pelvic incidence (PI), pelvic tilt (PT), lumbar lordosis (LL), the sagittal vertical axis (SVA) and the coronal Cobb angle. The visual analogue scale (VAS) score for low back pain, the Oswestry Disability Index (ODI) score were evaluated before and after surgery. Paired t test or repeated measures ANOVA was used to compare the data before and after surgery. Results: There were 6 males and 17 females with a mean age of (72±4) years (62-79 years). Nine patients were treated with LLIF and 14 patients with OLIF. Sixteen cases were implanted with three cages, five with two cages and two with four cages. The mean follow-up period was 24.2 months (15-42 months). After the first operation, the Cobb angle of the patient was significantly improved (18°±7° vs 33°±8°, t=13.2, P<0.01). All the parameters for sagittal balance, including PI-LL (20°±8° vs 31°±8(o)), SVA ((5.3±2.0) cm vs (8.2±3.5) cm), PT (16°±6° vs 23°±4°) were all significantly improved as well (t=6.8, 4.5, 9.0, ALL P<0.01). At the last follow-up, the VAS score of low back pain (3.4±1.1 vs 6.3±1.0) and ODI scores (27.3%±3.0% vs 47.1%±5.9%) were also significantly improved (t=11.3, 17.8, both P<0.01). No major complications occurred in this group. Conclusions: Minimally invasive LLIF/OLIF can significantly improve the coronal and sagittal balance of adult degenerative scoliosis. Staged minimally invasive surgery can significantly alleviate pain and improve function in these patients.


Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Escoliose/cirurgia , Fusão Vertebral/métodos , Adulto , Idoso , China , Avaliação da Deficiência , Feminino , Humanos , Vértebras Lombares , Masculino , Estudos Retrospectivos , Escoliose/patologia , Resultado do Tratamento , Escala Visual Analógica
3.
World Neurosurg ; 133: e745-e750, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31605853

RESUMO

BACKGROUND: Minimally invasive fusion of the sacroiliac (SI) joint has gained popularity for the treatment of refractory dysfunction. The purpose of this study was to compare the clinical outcomes of minimally invasive SI joint fusion between cylindrical threaded implants (CTIs) and triangular dowel implants (TDIs). METHODS: We retrospectively reviewed consecutive patients who underwent SI joint fusions with either CTIs or TDIs. Data collected included patient demographics, perioperative data, and all patient-reported outcomes (PROs) including postoperative visual analog scale (VAS), Oswestry Disability Index, and Short Form-12 at 6 months and 1 year. The change from baseline PROs between the cohorts was analyzed as the primary outcome. Secondary outcomes included revision rates and time to revision between the two cohorts. A P value <0.05 was considered significant. RESULTS: One hundred fifty-six consecutive patients underwent SI joint fusion, 74 patients with CTIs and 82 with TDIs. There was a significant difference in procedure length with CTI averaging 60.0 minutes (confidence interval: 55.7-64.3) and TDI averaging 41.2 minutes (confidence interval: 38.4-43.9, P < 0.0005). In both cohorts, there was a significant improvement in all PROs at 6 months when compared with preoperative values. However, when compared, there was no significant difference between the cohorts at 6-month follow-up or 1-year follow-up for either VAS-back, VAS-leg, Oswestry Disability Index, or Short Form-12. A 6.1% revision rate in the CTI cohort was observed compared with a 2.4% revision rate in the TDI cohort (P = 0.11). CONCLUSIONS: SI joint fusions with TDI or CTI offer a significant improvement in pain, disability, and quality of life. However, no difference was observed between devices to suggest superior clinical outcomes. Increased revision rates in the Rialto group warrants further investigation.


Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Articulação Sacroilíaca/cirurgia , Fusão Vertebral/instrumentação , Fusão Vertebral/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Próteses e Implantes , Estudos Retrospectivos , Titânio , Resultado do Tratamento
4.
World Neurosurg ; 133: e683-e689, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31568915

RESUMO

OBJECTIVE: The middle fossa craniotomy for tegmen defect repair provides wide access. This approach often requires temporal lobe manipulation, lumbar drain placement, and longer recovery. We describe a keyhole middle fossa approach with a simple titanium skull base repair that allows for wide access with no temporal lobe manipulation and does not require lumbar drain placement, which results in a dramatic reduction in hospital length of stay. METHODS: A retrospective review was performed on 14 consecutive patients with spontaneous cerebrospinal fluid (CSF) otorrhea. Each patient underwent a keyhole middle fossa approach followed by multilayer dural repair with titanium mesh "gull wing" skull base reconstruction. Postoperative measures included operative time, length of hospital stay, CSF leak recurrence, and surgical complications (seizures, hemorrhage, aphasia, infection). RESULTS: The average age of the patients was 60.7 ± 12.7 years old, and average body mass index was 32.8 ± 7.9 kg/m2. Nine of the patients were female. The average operative time was 103 ± 32.8 minutes. The average hospital length of stay was 1.4 days. There were no cases of postoperative CSF otorrhea, meningitis, aphasia, or seizures. There were no recurrences over a mean follow-up of 20.3 months (range: 5-48 months). CONCLUSIONS: A minimally invasive keyhole middle fossa approach with a multilayer dural reconstruction including titanium mesh "gull wing" skull base repair provides a quick, effective treatment for a broad spectrum of tegmen defects and meningoencephaloceles. This exposure and reconstruction technique do not require the use of a lumbar drain and result in minimal hospitalization.


Assuntos
Fossa Craniana Média/cirurgia , Craniotomia/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adulto , Idoso , Placas Ósseas , Otorreia de Líquido Cefalorraquidiano/cirurgia , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Titânio
5.
World Neurosurg ; 133: 1-7, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31541759

RESUMO

BACKGROUND: Recent studies have confirmed the effectiveness of minimally invasive endoscopic surgery for intracerebral hematoma (ICH). However, improvements are needed because incomplete hematoma removal may offset the surgical benefits of the technique. We describe a technique of neuroendoscopic surgery using an image detectable sheath, intraoperative computed tomography (iCT) scan, and a navigation system. METHODS: This is a retrospective study of 15 consecutive patients with spontaneous ICH who received neuroendoscopic surgery. During the surgery, a transparent sheath was fastened tightly to the scalp with 3.0 nylon. The patient's head was covered with a sterilized vinyl sheet and subsequent iCT scan visualized the orientation of the endoscopic sheath and the extent of residual hematoma, allowing the surgeon to decide to continue to remove the hematoma or to finish the treatment. RESULTS: The median hematoma evacuation rate was 93% (interquartile range, 82.2%-95.9%). The Glasgow Coma Scale score of all patients significantly improved at 1 week after the operation (P < 0.05). No complications associated with the procedure were observed. CONCLUSIONS: The combination of our techniques improves accuracy and safety of minimally invasive surgical evacuation of hematoma. Performing surgery with iCT scan also improves the spatial recognition of surgeons and therefore may be of educational value.


Assuntos
Hemorragias Intracranianas/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Monitorização Intraoperatória/métodos , Neuroendoscopia/métodos , Neuronavegação/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Hemorragias Intracranianas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Neuroendoscópios , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
6.
World Neurosurg ; 133: 34-40, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31541761

RESUMO

BACKGROUND: Stereoelectroencephalography (SEEG) is a commonly used technique for mapping the epileptogenic zone before epilepsy surgery. Many SEEG depth electrode implantation techniques involve the use of extensive technological equipment and shaving of the patient's entire head before electrode implantation. Our goal was to evaluate an SEEG depth electrode implantation technique that used readily available cost-effective neurosurgical equipment, was minimally invasive in nature, and required negligible hair shaving. METHODS: Data on demographic characteristics, operative time, hemorrhagic complications, implantation complications, infection, morbidity, and mortality among patients who underwent this procedure were reviewed retrospectively. RESULTS: Between April 2016 and March 2018, 23 patients underwent implantation of 213 depth electrodes with use of this technique. Mean (SD) operative time was 123 (32) minutes (range, 66-181 minutes). A mean (SD) of 9.3 (1.4) electrodes were placed for each patient (range, 8-13 electrodes). Two of the 213 electrodes (0.9%) were associated with postimplantation asymptomatic hemorrhage. One of the 213 electrodes (0.5%) was placed extradurally or incorrectly. None of the 213 electrodes was associated with symptomatic complications. No patients experienced infectious complications at any point in the preoperative, perioperative, or postoperative stages. CONCLUSIONS: This minimally invasive, cost-effective technique for SEEG depth electrode implantation is a safe, efficient method that uses readily available basic neurosurgical equipment. This technique may be useful in neurosurgery centers with more limited resources. This study suggests that leaving the patient's hair largely intact throughout the procedure does not pose an additional infection risk.


Assuntos
Eletroencefalografia/métodos , Epilepsia/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Técnicas Estereotáxicas/economia , Adulto , Análise Custo-Benefício , Eletroencefalografia/economia , Epilepsia/economia , Feminino , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/economia , Duração da Cirurgia , Estudos Retrospectivos , Adulto Jovem
7.
World Neurosurg ; 133: 358-365.e4, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31476471

RESUMO

OBJECTIVE: We compared the safety and effectiveness of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) to open TLIF (O-TLIF) for lumbar degenerative disease. METHODS: We systematically searched Medline, Embase, and the Cochrane Central Register of Controlled Trials for randomized trials of MI-TLIF versus O-TLIF. The perioperative outcomes included the procedure time, fluoroscopy time, blood loss, complications, and hospital stay. The midterm outcomes included pseudarthrosis, the Oswestry Disability Index, and pain severity-all reported at 1-year minimum follow-up. RESULTS: A total of 7 randomized trials including 496 patients (246 MI-TLIF; 250 O-TLIF) were included in our review. No statistically significant group differences in procedure time (mean difference [MD], -4 minutes; P = 0.70) were found. However, the fluoroscopy time was significantly longer with MI-TLIF (MD, 48 seconds; P < 0.001). MI-TLIF resulted in less perioperative blood loss (MD, -200 mL; P < 0.001) and shorter hospitalization (MD, -2.2 days; P < 0.001) compared with O-TLIF. The risk of perioperative complications was comparable between the 2 groups (risk ratio, 1.03; P = 0.94). No group differences were found in the incidence of pseudarthrosis at the 1-year minimum follow-up (risk ratio, 0.84; P = 0.67). Pain severity at midterm follow-up was comparable between the 2 groups (MD, -1; P = 0.59), and the ODI was slightly lower in the MI-TLIF group (MD, -3; P = 0.01). CONCLUSION: Relative to O-TLIF, MI-TLIF was associated with less blood loss, a shorter hospital stay, and slightly less disability, at the expense of longer fluoroscopy times.


Assuntos
Degeneração do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Fusão Vertebral/métodos , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
8.
Vet Clin North Am Small Anim Pract ; 50(1): 17-21, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31627990

RESUMO

Minimally invasive fracture repair (MIFR) is the ultimate culmination of current osteosynthesis concepts that emphasize the preservation and enhancement of the biologic components of fracture healing. Although the "less is more" approach to tissue dissection and fracture exposure and handling that defines MIFR has numerous reported advantages over more traditional open surgical treatments, it does present some unique challenges and important considerations for the surgeon. This article describes some of the general MIFR challenges a surgeon may encounter.


Assuntos
Fixação Interna de Fraturas/veterinária , Fraturas Ósseas/veterinária , Procedimentos Cirúrgicos Minimamente Invasivos/veterinária , Animais , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos
9.
Vet Clin North Am Small Anim Pract ; 50(1): 23-47, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31635912

RESUMO

Indirect fracture reduction is used to align diaphyseal fractures when using minimally invasive fracture repair. Indirect reduction achieves functional fracture reduction without opening the fracture site. The limb is restored to length and spatial alignment is achieved to ensure proper angular and rotational alignment. Fracture reduction can be accomplished using a variety of techniques and devices, including hanging the limb, manual traction, distraction table, external fixators, and fracture distractors.


Assuntos
Placas Ósseas/veterinária , Fixação Interna de Fraturas/veterinária , Fraturas Ósseas/veterinária , Procedimentos Cirúrgicos Minimamente Invasivos/veterinária , Animais , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Mesas Cirúrgicas/veterinária
10.
Vet Clin North Am Small Anim Pract ; 50(1): 263-271, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31635913

RESUMO

As the saying goes, "cats are not small dogs." Throughout veterinary medicine history, most of the literature focus has been on the canine. Feline patients, however, now constitute a larger proportion of the pet population and are unique in many aspects. They differ anatomically and biomechanically from canines and have specific recovery needs and different pain-related behaviors. It is important that veterinary surgeons understand these differences and improve their knowledge base in the treatment of cats. This article highlights the differences in cats relevant to minimally invasive fracture repair and how they affect a surgeon's approach to fractures in cats.


Assuntos
Placas Ósseas/veterinária , Doenças do Gato/cirurgia , Gatos/lesões , Fraturas Ósseas/veterinária , Procedimentos Cirúrgicos Minimamente Invasivos/veterinária , Animais , Fraturas Ósseas/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Especificidade da Espécie
11.
Vet Clin North Am Small Anim Pract ; 50(1): 213-230, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31635914

RESUMO

Articular fractures are common injuries in veterinary medicine. The principles of articular fracture repair are anatomic reduction and rigid fixation in order to optimize joint function. Fluoroscopy and arthroscopy are tools commonly used to allow for anatomic reduction with a minimally invasive approach. Minimally invasive techniques can decrease morbidity and promote an early return to function. Different types of articular fractures and options for minimally invasive repair are reviewed in this article.


Assuntos
Fixação Interna de Fraturas/veterinária , Fraturas Ósseas/veterinária , Articulações/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/veterinária , Animais , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Articulações/lesões , Procedimentos Cirúrgicos Minimamente Invasivos/métodos
12.
Vet Clin North Am Small Anim Pract ; 50(1): 207-212, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31648818

RESUMO

A concise review of the history of meta-bone fracture repair is provided. The relevant surgical anatomy, available instrumentation, and execution of preoperative, intraoperative, and postoperative surgical care using minimally invasive plate osteosynthesis are discussed in detail. A short discussion that touches on future directions for care of meta-bone fractures follows.


Assuntos
Placas Ósseas/veterinária , Fixação Interna de Fraturas/veterinária , Fraturas Ósseas/veterinária , Ossos Metacarpais/cirurgia , Ossos do Metatarso/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/veterinária , Animais , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Ossos Metacarpais/lesões , Ossos do Metatarso/lesões , Procedimentos Cirúrgicos Minimamente Invasivos/métodos
13.
Vet Clin North Am Small Anim Pract ; 50(1): 231-239, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31653535

RESUMO

Sacroiliac fracture-luxation is a common injury that is associated with ilial and acetabular fractures of the opposite hemipelvis. Sacroiliac fracture-luxation results in an unstable pelvis and potentially collapse of the pelvic canal. A minimally invasive approach to the reduction and insertion of a screw for fixation of sacroiliac fracture-luxation using fluoroscopic guidance is viable. The advantages of using this technique are that a small incision is made with minimal soft tissue disruption and the surgical time is short. Recent publications have documented that this technique provided superior repair of sacroiliac fracture-luxations.


Assuntos
Fixação Interna de Fraturas/veterinária , Luxações Articulares/veterinária , Procedimentos Cirúrgicos Minimamente Invasivos/veterinária , Articulação Sacroilíaca/cirurgia , Animais , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Fraturas Ósseas/veterinária , Luxações Articulares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Articulação Sacroilíaca/patologia
14.
Vet Clin North Am Small Anim Pract ; 50(1): 67-100, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31668598

RESUMO

Reviews of clinical outcomes led to the foundation of a new approach in fracture management known as biological osteosynthesis. As intramedullary rods featuring cannulations and locking devices at both extremities, interlocking nails are well suited for bridging osteosynthesis. Unique biological and mechanical benefits make them ideal for minimally invasive nail osteosynthesis and an attractive, effective alternative to plating, particularly in revisions of failed plate osteosynthesis. Thanks to a new angle-stable locking design, interlocking nailing indications have been expanded to osteosynthesis of epi-metaphyseal fractures, including those with articular involvement and angular deformities such as distal femoral varus and associated patellar luxations.


Assuntos
Pinos Ortopédicos/veterinária , Fixação Interna de Fraturas/veterinária , Fraturas Ósseas/veterinária , Procedimentos Cirúrgicos Minimamente Invasivos/veterinária , Animais , Fenômenos Biomecânicos , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos
15.
Vet Clin North Am Small Anim Pract ; 50(1): 155-182, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31668599

RESUMO

A thorough working knowledge of the anatomic landmarks of the femur facilitates anatomic alignment during minimally invasive osteosynthesis (MIO). A variety of fixation techniques, including plate, plate-rod, and interlocking nail, are well suited for stabilization of femoral shaft fractures with MIO techniques. Axis and torsional alignment can be assessed with various intraoperative techniques to ensure that anatomic alignment is obtained.


Assuntos
Fêmur/cirurgia , Fraturas Ósseas/veterinária , Membro Posterior/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/veterinária , Animais , Fêmur/lesões , Fraturas Ósseas/cirurgia , Membro Posterior/lesões , Procedimentos Cirúrgicos Minimamente Invasivos/métodos
16.
Vet Clin North Am Small Anim Pract ; 50(1): 183-206, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31733670

RESUMO

Fractures of the tibia and fibula are common in dogs and cats and occur most commonly as a result of substantial trauma. Tibial fractures are particularly amenable to treatment using minimally invasive fracture repair (MIFR) techniques that preserve blood supply to comminuted fracture fragments, accelerating bone callus production and speeding fracture healing. Treatment of tibial fractures using MIFR techniques has been found to reduce surgical time, reduce the time for fracture healing, and to decrease patient morbidity, while at the same time reducing complications compared with traditional open reduction and internal fixation.


Assuntos
Fíbula/cirurgia , Fixação Interna de Fraturas/veterinária , Fraturas Ósseas/veterinária , Membro Posterior/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/veterinária , Tíbia/cirurgia , Animais , Fíbula/lesões , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Membro Posterior/lesões , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Tíbia/lesões
19.
Khirurgiia (Mosk) ; (12): 121-125, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31825352

RESUMO

Minimally invasive approach in mitral valve surgery has been applied since the late 1990s. Considerable experience of mini-thoracotomy in cardiac surgery has been gained over this period. Stages of the development of minimally invasive cardiac surgery are reviewed in the article. Features of mitral valve surgery through right-sided mini-thoracotomy are discussed. Surgical outcomes of these procedures are reported considering data of various cardiac surgery centers. Moreover, the authors determined indications and limitations of this technique.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Doenças das Valvas Cardíacas/cirurgia , Valva Mitral/cirurgia , Toracotomia/métodos , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Resultado do Tratamento
20.
Zhonghua Wai Ke Za Zhi ; 57(12): 902-907, 2019 Dec 01.
Artigo em Chinês | MEDLINE | ID: mdl-31826593

RESUMO

Objectives: To evaluate the efficacy of minimally invasive surgery in patients with late severe tricuspid regurgitation after cardiac surgery, and to evaluate the role of leaflets augmentation technique in tricuspid valvuloplasty. Methods: From January 2015 to June 2019, 85 patients undergoing tricuspid valve repair procedure with minimally invasive approach at Department of Cardiovascular Surgery, Guangdong provincial People's Hospital were enrolled. There were 22 males and 63 females, aging of (53.6±12.4) years (range: 15 to 75 years). The interval between the prior and current operations was (16.0±7.3) years (range: 0.2 to 35.0 years). The diameter of right atrium and right ventricle was (77.3±17.2) mm and (61.0±8.4) mm, respectively. Tricuspid regurgitation was severe or extremely severe, the tricuspid regurgitation area was (19.0±10.3) cm(2). All patients underwent minimally invasive tricuspid valvuloplasty or tricuspid valve replacement on beating-heart with totally endoscopic technique and port-access approach through right chest wall. The operations included tricuspid valve replacement and tricuspid valvuloplasty, the technique of tricuspid valvuloplasty including leaflets augmentation with patch, ring implantation, chordae tendineaes reconstruction, release of papillary muscle, edge to edge method, etc. Postoperative hospitalization days, the time of ICU stay, blood transfusion rate, ventilator time and the results of echocardiography were recorded. Follow-up was completed regularly by WeChat, telephone and outpatient visit. Results: Sixty-five patients underwent tricuspid valve repair, and 20 patients underwent tricuspid valve replacement because of prosthetic failure and plasty failure. Five patients died during hospitalization, with mortality rate 5.9%. One patient was transferred to local hospital for anti-infection treatment, the other 79 patients were discharged from hospital in well condition and followed-up. The postoperative hospitalization time was 7.0 (5.5) days (M(Q(R))) days, the mean ventilator time was 18.0 (16.2) hours, and the mean ICU stay time was 68.0 (75.5) hours. There were 35 patients without blood conduction transfusion, the transfusion rate was only 58.9% (50/85). Four cases of severe, 9 cases of moderate and 67 cases of mild to zero tricuspid regurgitation were examined before being discharged, with tricuspid regurgitation area of (2.8±3.5) cm(2) (range: 0 to 19.1 cm(2)). The follow-up time was 1 to 38 months. Two patients died during follow-up, one patient died from infective endocarditis and mitral perivalvular leakage, the other one died of intractable right heart failure. One patient was implanted with permanent pacemaker due to Ⅲ atrioventricular block. Valvular re-replacement was performed in 2 patients who were re-admitted for the artificial valve infection and mechanical valve obstruction. No re-operation of tricuspid valve. Conclusions: Totally endoscopic minimally invasive technique provided satisfactory surgical outcomes for critically sick patients with severe tricuspid regurgitation following cardiac surgery. The application of leaflets augmentation technique achieved ideal repair effect for previously unrepairable lesions.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Insuficiência da Valva Tricúspide/cirurgia , Adolescente , Adulto , Idoso , Procedimentos Cirúrgicos Cardíacos/métodos , Feminino , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Reoperação , Resultado do Tratamento , Valva Tricúspide/cirurgia , Insuficiência da Valva Tricúspide/etiologia , Adulto Jovem
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