A Comparative Study Of Cardiac Surgery With Minimally Right Anterior Thoracotomy Using Special Superior And Inferior Vena Caval Shunt Compared With Using Routine Minimally Incision

Objective:Cardiac surgery has been widely carried out in the world as a routine operation,and the minimally right anterior thoracotomy heart surgery technology continues to improve,has been gradually popularized in the major cardiovascular centers.Some of these procedures include the operation of the right atrium path,and the difficulty of operation is obviously different from that of simple left atrial heart surgery.How to complete such surgery efficiently and safely has always been one of the concerns of cardiac surgeons.This study summarized the experience of cardiac surgery of right atrium path with small right thoracic incision under the condition of optimizing femoral vein intubation with special superior and inferior vena caval shunt tube,and compared it with the traditional right thoracic incision,right atrial trail cardiac surgery,by propensity score matching.Methods:Our study is a single-center retrospective cohort study.Cases were selected from January 2014 to December 2018,and cardiac surgery was performed in the center using a special superior and inferior vena caval shunt on the right atrium path of the minimally right anterior thoracotomy,containing 26 cases of mitral valvuloplasty/replacement+tricuspid valvuloplasty,17 cases of heart-beating tricuspid valvuloplasty and 28 cases of atrial septal defect repair.By means of propensity score matching,1:1 patients with cardiac surgery using minimally right anterior thoracotomy including right atrial trail were selected as the control group,compared with the special drainage tube group.Results:1.Mitral valve surgery+tricuspid valvuloplasty:There were no deaths in both groups,of which there were 4 cases(15%)with postoperative complications in special drainage tube group while 4 cases(15%)in regular group.Two groups had no significant difference.The average operation time?cardiopulmonary bypass time?the ratio of>100min CPB time and the aortic occlusion time of the special drainage tube group were shorter than that of the conventional small incision group(166±22min VS.224±58min,P<0.001;84±13min VS.101±22min,P=0.002;1(4%)VS.11(42%),P=0.001;53±10min VS.62±8min,P=0.001).The average intraoperative and postoperative hemorrhage?the average hospitalization time of the special drainage tube group has no significant differance with that of the regular group.The total cost of the special drainage tube group is significant lower than that of the regular group.2.Heart-beating tricuspid valve surgery:There were no deaths in both groups,of which there were 6 cases(35%)with postoperative complications in special drainage tube group while 5 cases(29%)in regular group.Two groups had no significant difference.The average operation time?cardiopulmonary bypass time and the ratio of>150min operation time of the special drainage tube group were shorter than that of the conventional small incision group(99±29min VS.148±34min,P<0.001;49 ±22min VS.68±21min,P=0.014;1(6%)VS.8(47%),P=0.007).The average intraoperative and postoperative hemorrhage?the average hospitalization time and the total cost of the special drainage tube group has no significantly differance with that of the regular group.3.Atrial septal defect repair:There were no deaths in both groups,of which there were 3 cases(11%)with postoperative complications in special drainage tube group while 4 cases(14%)in regular group.Two groups had no significant difference.The average operation time?cardiopulmonary bypass time?the ratio of>150min operation time and the ratio of>80min CPB time of the special drainage tube group were shorter than that of the conventional small incision group(128±20min VS.184 ±31min,P<0.001;71±12min VS.83±10min,P<0.001;0(0%)VS.14(50%),P<0.001;6(23%)VS.14(50%),P=0.026).The average intraoperative and postoperative hemorrhage?the average hospitalization time and the total cost of the special drainage tube group has no significantly differance with that of the regular group.4.Pain Assessment:The pain rating score for all patients before discharge showed that in the proportion of painless?mild and moderate pain in surgical wound,there was no significant difference between the special drainage tube group and the regular group(1(1%)VS.0(0%),P=0.316;66(93%)VS.66(93%),P=1.000;4(6%)VS.5(7%),P=0.731).Conclusion:The cardiac surgery with the minimally right anterior thoracotomy in the small superior and inferior vena caval shunt tube was compared to the right atrium path with the conventional minimally right anterior thoracotomy by means of propensity score matching.It can be seen that the average operation time and the cardiopulmonary bypass time can be significantly improved by using the special shunt.There was no increasing of the intraoperative and postoperative hemorrhage,as well as the ratio of perioperative complications.The average postoperative hospitalization time of some group patients was also shortened.It can be basically proved that the operation of minimally right anterior thoracotomy with special shunt is safe and reliable,and can optimize the existing operation,not only effectively shorten the operation time,but also has no negative effect on the overall prognosis of patients.It is worth for clinical popularization.