Objective To investigate the feasibility and safety of left atrium superior approach in mitral valve surgery. Methods The patients ( n=46 ) had mitral valve surgery from Aug. 2011 to Mar. 2012 were chosen and divided into superior approach group ( with left atrium superior approach ) and control group ( with other approaches, each n=23 ) . The exposure degree of surgical fields and surgical effect were compared between two groups. Results All patients had successful operations at the first time in two groups. The patients in superior approach group with satisfied exposure of mitral valve ( showing completed mitral valve ) accounted for 60.87% and those with general exposure ( showing most mitral valve ) accounted for 34.78%, and two groups had no incision expanding or changing surgical approach. There were no statistical differences between two groups in average cardiopulmonary bypass time [ ( 80 ± 21 ) min vs. ( 86 ± 27 ) min], average aortic cross clamp time [ ( 50 ± 14 ) min vs. ( 60 ± 17 ) min], average postoperative hospital stay [ ( 11 ± 4 ) d vs. ( 12 ± 4 ) d] and postoperative 24-hour chest tube output [ ( 311 ± 63 ) ml vs. ( 276 ± 78 ) ml]. The incidence of adverse events had no statistical difference between two groups ( P>0.05 ) during hospital stay and follow-up duration. Conclusion Left atrium superior approach in mitral valve surgery is a safe and feasible surgical method with reliable short-term effect, while its long-term effect needs further follow-up.%目的 探讨二尖瓣手术左房顶入路的可行性及安全性.方法 纳入2011年8月～2012年3月行二尖瓣手术患者46例,其中选取左房顶入路者纳入左房顶组(n=23),其他入路(房间隔或房间沟入路)者纳入对照组(n=23),比较两组患者手术视野显露程度和手术效果.结果 两组病例均一次手术成功,左房顶组二尖瓣显露满意(可显露二尖瓣全貌)占60.87%,一般显露(可显露二尖瓣大部分)占34.78%,均未在术中扩大切口或变更手术入路,左房顶组和对照组平均体外循环时间[(80±21)min vs.(86±27)min]、平均主动脉阻断时间[(50±14)min vs.(60±17)min]、术后平均住院时间[(11±4)d vs.(12±4)d]、术后24小时胸腔引流量[(311±63)ml vs.(276±78)ml]均无统计学差异(P＞0.05),两组院内和随访期间不良事件发生率无统计学差异(P＞0.05).结论 左房项入路行二尖瓣手术是一种较为安全可行的手术方式,近期效果切确,远期预后需进一步随访.
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