Clinical Analysis Of Incision Of Upper Sternum And Conxentional Incision Aortic Valve Replaceent

BackgroundAortic valve disease is a cardiovascular disease that seriously affects human health and has a poor prognosis,affecting approximately 2% of adults.Traditional mid-incision full-hand sternal saw valve replacement is the only way to cure symptomatic aortic valve disease.It is safe and effective,but the incision is long,the scar is obvious,and the trauma is difficult to satisfy the patient.Under the minimally invasive concept,minimally invasive aortic valve surgery has been developed,and a variety of minimally invasive aortic valve replacement have been used in clinical practice.Compared with foreign countries,the development of minimally invasive aortic valve replacement in China is relatively late,and the relevant clinical experience and other reports are few.There is still insufficient evidence to prove that the minimally invasive and traditional methods are better,combined with the development of our hospital.Minimally invasive transsphenoidal small incision aortic valve replacement to explore its clinical effects and summarize the experience.ObjectiveRetrospective analysis of the clinical data of aortic valve replacement in the upper sternum and the conventional aortic valve replacement in our hospital.The clinical effects of the two procedures were compared and the small incision of the upper sternum was evaluated objectively.The clinical efficacy and feasibility of valve replacement,combined with literature review of the experience of small incision aortic valve replacement in the upper sternum to promote the further development of the procedure.Materials and MethodsThe 43 patients who underwent aortic valve replacement with aortic valve disease from January 1st,2018 to January 19 th,2019,Department of Cardiology,Guangxi Medical University,were selected as subjects.The small incision of the upper sternum was a minimally invasive aortic valve replacement.The conventional incision aortic valve replacement was a routine group,including 20 patients in the minimally invasive group and 23 patients in the conventional group.All patients required a combination of medical history,symptoms and signs and auxiliary examination to diagnose a simple aortic valve disease,age<75 years old and require surgical intervention.In addition,all patients underwent transthoracic echocardiography(TTE)to diagnose simple aortic valve disease after admission,and excluded coronary heart disease(CAG was excluded from routine coronary artery disease over 50 years old),excluding previous history of chest or thoracotomy,thoracic deformity,small aortic root,coronary malformation shift,pericardial adhesion,severe atrioventricular block,acute heart failure,severe pulmonary hypertension,emergency surgery.All patients underwent aortic valve replacement under general anesthesia.The clinical data of the two groups were collected.The statistical analysis wasperformed using SPSS20.0 statistical software to analyze the differences.ResultAll cases were successful,no perioperative death,and no low cardiac output syndrome.There were no complications such as cerebral infarction,cerebral hemorrhage,liver and kidney failure,and severe arrhythmia in both groups.There was no traditional incision surgery in the minimally invasive group,and no re-opening thoracic hemostasis was performed in either group.Compared with the traditional group,the minimally invasive group had a slightly longer extracorporeal circulation time,a longer aortic occlusion time,a shorter CSICU stay,a shorter tracheal intubation time,less drainage on the first day after surgery,and a second day after the operation.Less,postoperative hospital stays were few,the average pain score was low,and the length of the surgical incision was short,and the difference was statistically significant.The operation time,the proportion of postoperative blood transfusion),the incidence of postoperative pneumonia,hospitalization expenses,preoperative left ventricular end-diastolic diameter,left ventricular ejection fraction,and cardiothoracic ratio were not statistically significant.Compared with the conventional group,the minimally invasive group has advantages over the conventional group in terms of beauty,pain relief,postoperative exudation,and postoperative recovery.There were no deaths after 3 months of follow-up and 3months of follow-up.All patients had improved cardiac function,no valvular and paravalvular leaks,no new arrhythmia,and satisfactory results for surgical treatment.Conclusion1.Aortic valve replacement through the small sternal incision can achieve the same surgical results as traditional aortic valve replacement,safe andeffective.2.Small incision aortic valve replacement in the upper sternum does not increase surgical complications,has good medical cosmetic effect,relieves pain,reduces exudation,postoperative recovery is fast,and it is worthy of clinical application..3.The technical requirements for small incision aortic valve replacement in the upper sternum are equivalent to those of conventional aortic valve replacement.The surgeon with rich experience in aortic valve replacement can fully grasp it with a little practice,and it is easy to accept and convenient to promote.