A Comparative Study On Video-assisted Thoracoscopic Minimally Invasive Mitral Valve Replacement And Conventional Surgery Incisions

ObjectivesThere have been a great variety of minimally invasive cardiac surgeries performed in the Heart Centers of China, and they all achieve good effects. The thesis summarizes the experience in video-assisted thoracoscopic minimally invasive mitral valve replacement surgeries. Additionally, further comparison of its clinical results with the conventional sternotomy mitral valve replacement is also demonstrated in the thesis.Methods56patients were selected based on the standard that they are under the age of60with rheumatic heart disease or mitral regurgitation; without aortic valve disease; NYHA class Ⅱ-Ⅲ; and never done a cardiothoracic surgery previously. Patients are divided into2random groups. The26patients in group A (thoracoscope group) accepts video-assisted thoracoscopic minimally invasive MVR by having minor incision (4-6cm) and two holes (for thoracoscope and ascending aorta clamp entry) cut on their right chest walls. Cardiopulmonary bypass (CPB) is established by femoral artery and femoral vein intubation, and the ascending aorta is blocked with a long clamp. Cardiac muscles are protected by filling in cardioplegia. The30patients in group B (regular group) accept mitral valve replacement by conventional mid-sternal incision and inferior, superior vena cava incubation CPB. Compare CPB time, cross clamp time, blood transfusion, hospital stay, and pain degree of both groups.ResultsNo death, low cardiac output syndrome, central nervous system complications are observed in both groups. No perivalvular leakage is observed on any patients. If the thoracoscope group is compared with the regular group, there’s no statistics difference (P>0.05) in their CPB [(101±27) min versus (93±26) min], ascending aorta block time [(57±18) min versus (41±15) min], and time of ventilation after surgery [(10.4±3.5) h versus (10.7±3.4) h]. However, the chest fluid drainage of thoracoscope group significantly decreases [(78±26) ml versus (109±43) ml (P<0.01)], and there’s obvious drop in hospital stay time of thoracoscope group [(10.3±2.1) d versus (14.2±3.7) d (P<0.05)]. Additionally, the thoracoscope group has less pain after surgery than the patients in regular group. The incision length of thoracoscope group is much less than those of the regular group [(5.0±1.1) cm versus (22.3±2.6) cm]. Patients from thoracoscope group are more satisfied about the appearance of their incisions.ConclusionCompared with mid-sternal thoracotomy, video-assisted thoracoscopic minimally invasive mitral valve replacement surgery is safer and more reliable with satisfactory surgery effects. It incurs smaller incision, less bleeding, shorter hospital stay, less pain after surgery, and more satisfactory incision appearance.