| Objective:Minimally invasive Mitral valve surgery has been a routine procedure in the Cardiac surgery center all over the word,with a lot of good outcomes being reported.At present,different studies of minimally mitral valve surgery did not reach an agreement.We summarized the experience in video-assisted thoracoscopic right minithoracotomy mitral valve surgery in our center.Additionally,we compared the outcome of right minithoracotomy mitral valve surgery with median sternotomy procedure by using propensity score matching.Methods:This was a single-center retrospective cohort study.There were 49 patients underwent the minimally invasive mitral valve repair,and 54 patients underwent the minimally invasive mitral valve replacement from 2014 to 2016.With propensity score matching,we selected 47 patients after mitral valve repair and 54 patients after mitral valve replacement through a median sternotomy to be the control groups.Results:1.Mitral ValvuloplastyThe hospital mortality of both groups was 0.The postoperative morbidity was 4.3%in the minimally invasive group and 8.5%in the control group,and there were no statistically significant differences between the two groups.The aortic cross clamp and CPB times of minimally invasive group were significantly longer than the control group(108.7±29.4min vs.76.5±20.3min,p<0.001;70.0±21.4 min vs.49.6±17.1min,p<0.001).However,the Intraoperative blood loss and postoperative drainage volume of minimally invasive group were much less than the control group(144±82.9ml vs.238±72.4ml,p<0.001;469.6±443.5ml vs.676.5±377.6ml,p=0.017).Similarly,the ICU stay was shorter in the minimally invasive group too.2.Mitral valve replacementThe hospital mortality of both groups was 0.The postoperative morbidity was 13%in the minimally invasive group and 9.3%in the control group,and there were no statistically significant differences.The aortic cross clamp,CPB and entire operation time of minimally invasive group were significantly longer than the control group(188.7±43.0min vs.161.8±40.2min,p=0.001;104.7±32.7min vs.73.8±15.5min,p<0.001;66.9±25.6min vs.46.0±14.6min,p<0.001).However,the Ventilation time of the minimally invasive group was shorter.The Intraoperative blood loss and postoperative drainage volume of minimally invasive group were much less than the control group(141.7±98.9mL vs.240.7±71.4mL,p<0.001;519.9±349.3mL vs.673.7±389.2mL,p=0.033).Similarly,the ICU stay was shorter in the minimally invasive group too.3.Pain assessmentChest pain was assessed at rest before the patient discharge,using the Verbal Rating Scale.The minithoracotomy approach was compared to sternotomy with a significant reduction of pain level(no pain:62.4%vs.36.6%,p<0.001,mild pain:33.7 vs.57.4%,p<0.001).4.Learning curveThere was a statistically significant reduction in operation time and Intraoperative blood loss in the minimally invasive group during the study period.Operation time decreased from 207.1±41.9 minutes in 2014 to 181.9±47.0 minutes in 2016(P<0.05).The intraoperative blood loss volume diminished over the study period,from 211.7± 108.3 mL in 2014 to 123.8±79.6 mL in 2016(p<0.05).Conclusions:The MIMVS appeared to be feasible,safe,and efficient with excellent cosmetic results and to have a mortality and postoperative morbidity rate comparable to that of conventional MVS.MIMVS resulted in a reduced Postoperative drainage volume,diminished intraoperative bleeding,lower pain level and shorter ICU and hospital stays. |
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