乳輪切開アプローチによる三尖弁手術

Tricuspid Valve Surgery through Transareolar Approach

右小開胸アプローチは弁膜症手術において胸骨正中切開と並ぶ標準的なアプローチである1）．多くの場合前腋窩線あるいは乳房下線上に皮膚切開がおかれるが，右房切開による心内操作を行う場合，乳輪切開を行うと，より前方からアプローチできる利点がある2）．本稿では当科における乳輪切開アプローチによる三尖弁手術の治療成績について検討する．

Right minithoracotomy has become the standard approach along with sternotomy in mitral and tricuspid valve surgery. Transareolar incision, compared with submammary incision, is advantageous in that it often allows better angle for antegrade cardioplegia cannulation through the main wound. It also provides a better cosmesis. In this retrospective study, we reviewed the 11 patients who underwent minimally invasive tricuspid valve repair through transareolar approach from 2016 to 2019. Mean age was 58 years, 8 ware female, mean body weight was 53 kg, and mean body surface area was 1.47 m2. Causative pathology was atrial septal defect in 8, trauma in 1, tumor in 1 and pacemaker lead infection in 1. Homologous blood transfusion was performed in 1. Hospital mortality occurred in 1；a patient on dialysis who underwent tricuspid valve repair with removal of vegetation for pacemaker lead infection died of uncontrollable acidosis. There was no late death. Transareolar approach was considered a feasible option for tricuspid valve surgery.