Comparison Of Clinical Effects Of Video-assisted Right Thoracic Mini-incision Mitral Valve Replacement And Traditional Median Thoracotomy Mitral Valve Replacement

Objective:To explore the advantages and disadvantages of thoracoscope-assisted small incision operation and traditional median thoracotomy in the treatment of mitral valve replacement,and evaluate the safety and effectiveness of the both,so as to choose more reasonable,safe and effective mode of operation for patients.Methods:The clinical data of 64 patients diagnosed with mitral valve disease from January2018 to December 2020 in the Department of Cardiovascular Surgery of The 2nd Affiliated Hospital of Nanchang University were analyzed retrospectively.35 patients who underwent thoracoscopic-assisted right mini-thoracotomy mitral valve replacement were used as the thoracoscopic group,and the other 29 cases who underwent traditional median thoracotomy mitral valve replacement served as the control group.The clinical data of the two groups were compared.Results:There was no transition to thoracotomy in the thoracoscopic group,and all patients recovered and discharged smoothly after the operation,with no deaths.(1)There was no statistically significant difference in preoperative general data(height,weight,age,left ventricular ejection fractions,left ventricular end-diastolic diameters)(P>0.05);(2)The cardiopulmonary bypass time and aortic clamping time in the thoracoscopy group were longer than those in the control group,and the difference was statistically significant(P < 0.05),while the operation time had no statistical significance between the two groups(P>0.05).The difference of the intraoperative blood loss of the thoracoscopic group and the control group was statistically significant(P<0.05),the thoracoscopic group was less than the control group;The difference between the intraoperative blood transfusion volume of the thoracoscopic group and the control group was not statistically significant(P>0.05);(3)The postoperative ventilator assist time,CSICU stay time,24 h thoracic drainage volume and hospitalization time in the thoracoscopic group were all less than those in the control group,and the difference was statistically significant(P<0.05);There was no significant difference in total blood transfusion,total hospitalization cost,postoperative left ventricular ejection fraction and left ventricular end-diastolic diameter between thethoracoscopic group and the control group(P>0.05);Postoperative complications: sinus arrest occurred in 1 case in the endoscopic group,pleural effusion occurred in 1 case,the total adverse incidence was 5.7%,and1 case of postoperative poor wound healing occurred in the control group,with a total adverse incidence of 3.4%.Conclusions:The incidence of postoperative complications of thoracoscopic-assisted mitral valve replacement does not increase,which is as safe and reliable as the traditional operation,and did not prolong the operation time,and the cost is not significantly different from that of the traditional operation,with small incision,less bleeding and rapid postoperative recovery.under the premise of selecting suitable patients,if the problem of prolonging the time of cardiopulmonary bypass can be solved,it has more advantages than traditional median thoracotomy.