Comparison Between Video-assisted Right Anterolateral Minithoracotomy And Conventional Sternotomy Approaches For Mitral Valve Surgery

Objective:With the development of cardiac surgery,the improvement of anaesthesia and cardiopulmonary bypass(CPB)technology along with patients’ requirement of high quality of life,minimally invasive cardiac surgery(MICS)came to public’s view.In recent years,small incision cardiac surgery with video-assisted has been widely practiced due to its advantages of small wound and quick recovery.Through a retrospective analysis,this research aims at comparing the video-assisted right anterolateral minithoracotomy with traditional median sternotomy for mitral valve surgery,analyzing perioperative clinical data,in order to assess the effects and safety of this surgical approach.Methods:This research is a retrospective analysis,which includes 80 cases of mitral valve surgery practiced in our center during 2011 to 2015.wherein,40 cases are video-assisted right anterolateral minithoracotomy for mitral valve surgery(video-assisted group),and the other 40 cases are median sternotomy mitral valve surgery(conventional group).The perioperative clinical information of patients in 2 groups was obtained from medical records,including data during operation(cardiopulmonary bypass time,aorta-clamping time,automatic heart re-beat rate,urine during the cardiopulmonary bypass,ultrafiltration volume,and operation time)and post-operation(tracheal intubation time,ICU stay,postoperative hospital stay,chest tube drainage in 24 hours after operation,blood transfusion,death and severe complication).Quantitative variables are expressed as mean 士 standard deviation,and categorical variables are expressed as percentages.For comparison,Mann-Whitney U or Pearson Chi-Square(or Fisher’s Exact Test)were used.The p-value<0.05 was considered as statistically significant using SPSS 17.0 software.Results:All operations were completed successfully,and there was no death case within 30 days after operation.No postoperative permanent neurologic damage happened.There were 2 cases of re-exploration for bleeding in the video-assisted group,and 1 case in the conventional group.There was 1 case of incision infection in the conventional group,but not in the video-assisted group.The chest tube drainage in first 24 hours post-operation,postoperative tracheal intubation time,and postoperative hospital stay of the video-assisted group were obviously less than the conventional group,which were statistically significant(P<0.05).Post-operation ICU stay,allogeneic erythrocyte transfusion and plasma transfusion per case of the video-assisted group were less than the conventional group,which were not statistically significant(P≥0.05).Cardiopulmonary bypass time of the video-assisted group was longer than the conventional group without statistical significance(P<0.05).Aorta-clamping time and operation time of the video-assisted group was longer than the conventional group without statistical significance(P≥0.05).Urine during the cardiopulmonary bypass of the video-assisted group was more than the conventional group with statistical significance(P<0.05).Otherwise the automatic heart re-beat rate and intraoperative ultrafiltration between 2 groups showed no statistical significance(P≥0.05).Conclusion:With doctors’ proper training of minimally invasive surgery,and appropriate selection of patients,video-assisted right anterolateral minithoracotomy for mitral valve surgery can achieve the similar safety as conventional surgery with smaller wound,less bleeding,quicker recovery.Video-assisted right anterolateral minithoracotomy for mitral valve surgery shows great potential in clinical practice.