The Application Of Thoracoscope-Assisted Mitral Valve Replacement With A Small Incision In The Right Chest In The Elderly

Object:Collecting,comparing and analyzing the clinical data of elderly patients accepted the operation of thoracoscope-assisted mitral valve replacement via a right thoracic minimal incision and conventional mitral valve replacement,to summarize the experience of the operation of thoracoscope-assisted mitral valve replacement via a right thoracic minimal incision in the elderly and evaluate the surgical safety and clinical effect.Methods:The clinical date of 68 patients over 60 years old who had mitral valve disease were analyzed retrospectively from August 2012 to August 2016 on our hospital.Depending on the operational methods,the patients were divided into two groups.The thoracoscope-assisted group included 28 patients undergoing thoracoscope-assisted mitral valve replacement via a right thoracic minimal incision,and the conventional group included 40 patients undergoing conventional mitral valve replacement.We collected and analyzed the date of general information,operation time,aortic clamping time,CPB time,breathing machine time,intensive care time,thoracic drainage liquid,blood transfusion,postoperative analgesia time,hospitalization time,incision length,cost of hospitalization,postoperative complications and the data of postoperative ultrasound.Results:In the aspects of general information,operation time,aortic clamping time,CPB time,death rate,breathing machine time,intensive care time and cost of hospitalization,the differences of two groups had no statistical significance.Comparing with the conventional group,in the aspects of postoperative analgesia time,postoperative hospital stay,thoracic drainage liquid,blood transfusion,length of incision,the thoracoscope-assisted group had obvious superiority.In the aspects of postoperative complications:the incidence of death,cerebrovascular accident,renal insufficiency,hepatic insufficiency,digestive tract hemorrhage,low cardiac output syndrome,lung insufficiency,heart failure and arrhythmia,the two group had no differences.The conventional group had more patients of pulmonary infection,incision bad healing and second time operation to stop bleeding,while the thoracoscope-assisted group had more patients of postoperative pneumothorax and subcutaneous emphysema.Patients of two groups had no cerebral infarction,cerebral hemorrhage,delayed recovery,valve leakage,mitral valve flap and replacement mitral valve second time.All patients alive were followed up more than 1 years after surgery,and the ultrasound data of the two groups of 3 months and 1 year after operation had no significant difference.Conclusion: The application of thoracoscope-assisted mitral valve replacement with a small incision in the right chest in the Elderly had the same clinical efficacy and safety as conventional mitral valve replacement.Because the operation of thoracoscope-assisted mitral valve replacement via a right thoracic minimal incision had the advantages of less trauma,less bleeding,less pain and faster recovery,it is a good operation method for the elderly.