| Through the retrospective analysis of the case method,compared with minimally invasive right anteriorlateral incision(60 cases of mitral valve,30 cases of aortic valve,50 cases of adult congenital heart disease)and traditional median incision cardiac surgery(60 cases of mitral valve,30 cases of aortic valve,50 cases of adult congenital heart disease)clinical results,postoperative complications and quality of life.The safety and clinical efficacy of minimally invasive right anterior lateral small incision in the treatment of cardiac disease were comprehensive evaluated.Part?:Comparison of minimally invasive right thoracic incision withtraditional incision in the treatment of mitral valve diseaseMethodsA retrospective analysis of 80 patients with mitral valve disease treated in our hospital from March 2013 to march 2015 were enrolled in this study.40 patients with normal mitral surgery group and 40 cases with minimally invasive right anterior lateral incision surgery group were treated.The preoperative parameters,intraope-rative parameters,postoperative parameters,postoperative complications,and Follow-up outcomes were compared between the two groups,respectively.Results1.There was no significant difference between two groups preoperative indicators(P>0.05).2.The time of cardiopulmonary bypass and the time of aorta occlusion were significantly higher than those of the traditional group(P<0.05).Minimally invasive group of less blood loss than the traditional group(P<0.05).There were no significant differences between the two groups in the operation time,cardiopulmonary bypass build time,the rate of auto resuscitation,intraoperative perfusion flow,intraoperative mean perfusion pressure,operation mode and so on(P>0.05).3.The postoperative ventilator-assisted time,postoperative hospital stay,postoperative 24-hour drainage,postoperative blood transfusion rate,pulmonary infection,arrhythmia and incision length were shorter than those in the traditional group(P<0.05).There was no significant difference in postoperative intensive care unit length of stay,postoperative atrial fibrillation to sinus rhythm,secondary thoracic hemostasis,incision infection,sepsis,pericardial tamponade,pleural effusion,low cardiac output syndrome,acute renal insufficiency,liver damage,right side of the diaphragm elevation,neurological dysfunction,technical errors(P>0.05).There were no hospital deaths in the both groups.4.There were significant differences in EF values,LAD and LVEDD between the minimally invasive groups before and after operation(P<0.05).There were significant differences in EF value,LAD and LVEDD between the traditional group before and after surgery(P<0.05).The EF value of the minimally invasive group was significantly higher than that of the conventional group(P<0.05),but LAD and LVEDD,no significant difference after operation(P>0.05).5.Minimally invasive group of patients after two year of quality of life in all aspects and areas compared with the normal of WHOQOL-100 of independence field and medical means or drug dependence,the difference was significant(P<0.05);there was no significant difference compared with the normal of WHOQOL-100 in the aspects of physiological field,psychological field,social relations field,environmental field,spiritual pillar/religion/personal belief,quality of life and health status(P>0.05).There were significant differences in the physiological field,the psychological field,the independence field,the overall quality of life and the health status in all aspects and areas of the traditional group of patients after two year of operation compared with the normal of WHOQOL-100(P<0.05),there were no significant differences in the areas of social relations,environmental field,spiritual pillar/religion/personal belief compared with the normal of WHOQOL-100(P>0.05).There were significant differences between the two groups in overall quality of life and health status,physiology field,psychological field,independence field(P<0.05).There was no significant difference between the two groups in the field of social relations,environment and spiritual pillar/religion/personal belief(P>0.05).6.Two groups were followed up for 1 month,3 months,6 months,1 year in anticoagulation related complications,mitral regurgitation,tricuspid regurgitation,infective endocarditis,biological prosthesis decay,mechanical prosthesis loss of function,perivalvular leakage,cardiac function,postoperative death,etc,there was no significant difference(P>0.05).At 2 years follow-up,the minimally invasive group of cardiac function grade I was more than that of the traditional group,there are significant differences(P<0.05),The other side no significant difference(P>0.05).Part ?:Comparison of minimally invasive right thoracic incision withtraditional incision in the treatment of aortic valve diseaseMethodsA retrospective analysis of 60 patients with aortic valve disease treated in our hospital from March 2013 to march 2015 were enrolled in this study.30 patients with normal aortic surgery group and 30 cases with minimally invasive right thoracic incision surgery group were treated.The preoperative parameters,intraoperative parameters,postoperative parameters,postoperative complications,and Follow-up outcomes were compared between the two groups,respectively.Results1.There was no significant difference between two groups preoperative indicators(P>0.05).2.The operation time,the cardiopulmonary build time,the time of cardiopulmo-nary bypass and the time of aorta occlusion were significantly higher than those of the traditional group(P<0.05).Minimally invasive group of less blood loss than the traditional group(P<0.05).There were no significant differences between the two groups in the rate of auto resuscitation,intraoperative perfusion flow,intraoperative mean perfusion pressure,replacement valve type,size and other related indicators(P>0.05).3.The postoperative ventilator-assisted time,postoperative hospital stay,postoperative 24-hour drainage,postoperative blood transfusion rate and incision length were shorter than those in the traditional group(P<0.05).There was no significant difference in postoperative intensive care unit length of stay,postoperative secondary thoracic hemostasis,incision infection,pulmonary infection,sepsis,pericardial tamponade,pleural effusion,low cardiac output syndrome,acute renal insufficiency,liver damage,arrhythmia,neurological dysfunction(P>0.05).There were no hospital deaths in the both groups.4.There were significant differences in EF values between the minimally invasive groups before and after operation(P<0.05).There was no significant difference in LAD and LVEDD between the minimally invasive groups before and after operation(P>0.05).There were significant differences in LVEDD between the traditional groups before and after operation(P<0.05).There were no significant differences in EF value and LAD between the traditional group before and after surgery(P>0.05).The EF value of the minimally invasive group was significantlyhigher than that of the conventional group(P<0.05),but LAD and LVEDD,no significant difference after operation(P>0.05).5.Minimally invasive group of patients after two year of quality of life in all aspects and areas compared with the normal of WHOQOL-100 of independence field and medical means or drug dependence the difference was significant(P<0.05);there was no significant difference compared with the normal of WHOQOL-100 in the aspects of physiological field,psychological field,social relations field,environmental field,spiritual pillar/religion/personal belief,quality of life and health status(P>0.05).There were significant differences in the physiological field,the psychological field,the independence field,the environmental field,the overall quality of life and the health status in all aspects and areas of the traditional group of patients after two year of operation compared with the normal of WHOQOL-100(P<0.05),there were no significant differences in the areas of social relations and spiritual pillar/religion/personal belief compared with the normal of WHOQOL-100(P>0.05).There were significant differences between the two groups in physiology field,psychological field,independence fieldand social relations(P<0.05).There was no significant difference between the two groups in overall quality of life and health status,environment and spiritual pillar/religion/personal belief(P>0.05).6.Two groups were followed up for one month,three months,six months,one year in anticoagulation related complications,mitral regurgitation,tricuspid regurgita-tion,infective endocarditis,biological prosthesis decay,mechanical prosthesis loss of function,perivalvular leakage,cardiac function,postoperative death,etc,there was no significant difference(P>0.05).At two years follow-up,the minimally invasive group of cardiac function grade I was more than that of the traditional group,there are significant differences(P<0.05),The other side no significant difference(P>0.05).Part III:Comparison of minimally invasive incision with traditionalincision in the treatment of adult congenital heart diseaseMethodsA retrospective analysis of 100 patients with adult congenital heart disease treated in our hospital from March 2013 to march 2015 were enrolled in this study.50 patients with normal median incision surgery group and 50 cases with minimally invasive incision surgery group were treated.The preoperative parameters,intraope-rative parameters,postoperative parameters,postoperative complications,and Follow-up outcomes were compared between the two groups,respectively.Results1.There was no significant difference between two groups preoperative indicators(P>0.05).2.The time of cardiopulmonary bypass and the time of aorta occlusion were significantly higher than those of the traditional group(P<0.05).Minimally invasive group of less blood loss than the traditional group(P<0.05).There were no significant differences between the two groups in the operation time,cardiopulmonary bypass build time,the rate of auto resuscitation,intraoperative perfusion flow,intraoperative mean perfusion pressure,operation mode and so on(P>0.05).3.The postoperative ventilator-assisted time,postoperative intensive care unit length of stay,postoperative hospital stay,postoperative 24-hour drainage,postopera-tive blood transfusion rate and incision length were shorter than those in the traditional group(P<0.05).There was no significant difference in secondary thoracic hemostasis,incision infection,pulmonary infection,sepsis,pericardial tamponade,pleural effusion,low cardiac output syndrome,acute renal insufficiency,liver damage,the right side of the diaphragm height,arrhythmia,neurological dysfunction,technical errors,residual leak,atrioventricular block III(P>0.05).4.There was no significant difference in all aspects and areas of the minimally invasive group of patients after two year of operation compared with the normal of WHOQOL-100 in the aspects of physiological field,psychological field,independence field,social relations field,environmental field,spiritual pillar/religion/personal belief,quality of life and health status(P>0.05).There were significant differences in the physiological field,the psychological field,the independence field,social relations in all aspects and areas of the traditional group of patients after two year of operation compared with the normal of WHOQOL-100(P<0.05);there were no significant differences in the areas of environmental field,spiritual pillar/religion/personal belief,the overall quality of life and the health status compared with the normal of WHOQOL-100(P>0.05).There were significant differ-ences between the two groups in physiology field,psychological field,independence field and social relations,(P<0.05).There was no significant difference between the two groups in the field of overall quality of life and health status,environment,spiritual pillar/religion/personal belief(P>0.05).5.The two groups were followed up for one month,three months,six months,one year,two year in mitral regurgitation,tricuspid regurgitation,cardiac function,postoperative death,etc,there was no significant difference(P>0.05).ConclusionsMinimally invasive right anterior lateral small incision in the treatment of heart disease with small trauma,short hospital stay and high safety,is conducive to patients with postoperative recovery,cosmetology and postoperative patients with high quality of life,and therefore worthy of clinical application. |
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