| Objective:The aim of this study was to evaluate the safety,reliability and prevalence of complete thoracoscopic cardiac surgery for the treatment of mitral valve replacement combined with ablation of atrial fibrillation by comparing the short-term results of minimally invasive and sternotomy approaches.Methods:This was a retrospective,observational,cohort study of prospectively collected data.A total number of 228 cases of mitral valve replacement were screened out at the department of cardiac surgery in Xijing Hospital between January 2015 and January 2016.Only 118 cases of which underwent radiofrequency ablation at the corresponding period of mitral valve replacement.However,52 patients of the 118 cases needed to change surgical procedures due to other lesions found in the operation.So the rest 66 cases were finally chosen as the subjects of this study and divided into two groups:(1)Complete thorascopic cardiac surgery group(37 patients).Including 33 cases of rheumatic mitral stenosis with atrial fibrillation and 4 cases of rheumatic mitral insufficiency with atrial fibrillation.In this group,5 cases underwent mitral valve replacement surgery + radiofrequency ablation combined with tricuspid valve forming and the other 32 cases underwent mitral valve replacement + radiofrequency ablation.(2)Median sternotomy cardiac surgery group(29 patients).Including 24 cases of rheumatic mitral stenosis with atrial fibrillation and 5 cases of rheumatic mitral insufficiency with atrial fibrillation.In this group,4 cases underwent mitral valve replacement surgery + radiofrequency ablation combined with tricuspid valve forming and the other 25 cases underwent mitral valve replacement + of radiofrequency ablation.Perioperative parameters,postoperative outcome and recent follow-up results of the two groups were collected and analyzed to explore the benefits of the two operative ways for the patients.Results:Patients who underwent complete thorascopic cardiac surgery showed evident advantages than those with mid-sternotomy cardiac surgery in aspects of operation time(191.19±39.43 VS 220.54±43.23 min,P<0.05),CPB time(89.03±24.38 VS 117.93±16.51 min,P<0.05),posterior parallel circulation time(31.75±9.82 VS 45.82±14.2 min,P<0.05),sternal closure time(19.21±7.82 VS 56.21±7.82 min,P<0.01),quantity of postoperative bleeding(159.21±10.45 VS 259.34±15.43 ml,P<0.01),mechanical ventilation time(15.37±9.44 VS 20.96±10.18 h,P<0.05),intensive care unit time(51.05±9.82 VS 62.39±17.38 h,P<0.05),postoperative analgesic usage(11 VS 22,P<0.01),and drainage tube removal time(41.32±22.29 VS 61.18±19.24 h,P<0.05).However,there were no significant differences between the two groups in aspects of the aortic cross-clamp time,the occurrence of postoperative complications,the EF value at 3 months after surgery and the therapeutic effect of atrial fibrillation.Conclusion:Our study shows that complete thoracoscopic mitral valve replacement with radiofrequency ablation is a safe,and effective procedure and reduces operation time,CPB time,posterior parallel circulation time,sternal closure time,quantity of postoperative bleeding,mechanical ventilation time,intensive care unit time,postoperative analgesic usage and drainage tube removal time.Complete thorascopic surgery treatment of combined mitral valve replacement and radiofrequency ablation is worthy of being widely applied in clinical use. |
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