The Comparative Study Of Minimally Invasive Valve Surgery Through A Right Mini-thoracotomy(RM) Versus Standard Median Sternotomy In 152 Patients

ObjectiveWe sought to evaluate the potential benefits of minimally invasive approaches for surgery of isolated aortic and mitral valve disease, this retrospective study review our results and experience with a right mini-thorctomy(RM) technique for vavle surgery compared with standard median sternotomy(SMS).MethodsBetween, July 2009 and December 2009,76 patients accepted minimally invasive valve surgery through RM (minimally invasive group).This group was compared with 76 patients who underwent valve surgery though SMS during the same period (traditional group).Results1 In the minimally invasive group, an RM incision though the forth intercostal space was used in 28/24 MVR/MVP, an RM incision in the third intercostal space was used in 24 AVR; In the traditional group, the standard surgery procedure was finished in 30/22/24 MVR/MVP/AVR.2 Operative mortality was 0%(0/76) in the minimally invasive group and 2.6%(2/76) in the traditional group (P>0.05).There were no statistical differences in the re-exploration for bleeding rate,new onset atrial fibrillation,pneumonia,neurological events,septic wound complications (P>0.05); The minimally invasive group had less chest drainage than traditional group and required less blood transfusion (P<0.05) Postoperative mechanical ventilation time,ICU stay,hospital stay after operation was shorter in the minimally invasive group than in the traditional group (P<0.05),but the minimally invasive group was longer in the operation time,CPB time,aortic-clamp time (P<0.05) 3 The mean follow-up duration was 5.5 months(range 3～9 months),and the follow-up rate 96%.There was one late death in the minimally invasive mitral valve replace one week after discharge due to cerebral hemorrhage, and the death rate in the minimally invasive group was 1.3%,then there was no late death in the traditional group (P>0.05).There was one perivalvular leakage in the minimally invasive mitral valve replace and was treated pharmacotherapy. The follow-up TTE show that there was no mitral valve regurgitation more than no or trivial except one in the minimally invasive group. Patients returned to normal activity more quickly with RM than SMS (P<0.05)ConclusionThe MIVS though mini-thoracotomy can be performed with favorable cosmetic and clinical results. It provides a good alternative to standard median sternotomy.