The Comparative Study Of Right Chest Minimally Invasive Surgery And Traditional Median Incision In The Treatment Of Mitral Valve Disease

Objective The clinical effects,postoperative complications and quality of life of minimally invasive right anterolateral thoracotomy and traditional median thoracotomy in the treatment of mitral valve diseases were compared by retrospective comparative analysis.To investigate the clinical efficacy and safety of minimally invasive right anterolateral thoracotomy in the treatment of mitral valve disease,and to summarize the experience of minimally invasive right anterolateral thoracotomy in the treatment of mitral valve disease.Methods The patients with mitral valve disease treated in our hospital from February 2014 to February 2016 were analyzed retrospectively.96 patients were selected according to the selection criteria,including 40 patients(12 males).Minimally invasive right thoracic small incision was performed in 28 women(minimally invasive group),and traditional median incision was performed in 56 patients(20 males and 36 females).The minimally invasive group included mitral valve replacement(n = 31),mitral valvuloplasty(n = 9),tricuspid valvuloplasty(n = 16)and atrial fibrillation radiofrequency ablation(n = 12).The traditional group included mitral valvereplacement(n = 42),mitral valvuloplasty(n = 14),tricuspid valvuloplasty(n = 23)and atrial fibrillation radiofrequency ablation(n = 16).The preoperative indexes,operation mode,operation time,blocking time,establishment of cardiopulmonary bypass,blocking time,intraoperative perfusion volume,intraoperative mean perfusion pressure and intraoperative bleeding were analyzed and compared between the two groups.Volume,24 hours after operation,nursing time in intensive care unit,ventilator-assisted breathing time,cardiac function grade and postoperative complications.Results There were no hospital deaths in both groups,and there was no significant difference in hospital mortality between the two groups(P>0.05).There was no significant difference in cardiac function,weight,age,height,sex and body surface area between the two groups before operation(P>0.05).The time of cardiopulmonary bypass(CPB)was(158.8±50.7)min in the minimally invasive group,(87.9±27.2)min,in the traditional group,(121.6±62.2)in the traditional group and(56.2±19.1)in the traditional group.There was significant difference between the two groups(P<0.05).There was no significant difference in cardiopulmonary bypass time,operation mode,intraoperative perfusion flow and automatic cardioversion rate between the two groups.There were significant differences in EF,LAD and LVEDD between pre-operation and post-operation in the minimally invasive group(P<0.05).There were significant differences in EF,LAD and LVEDD between pre-operation and post-operation in the traditional group(P<0.05).There were significant differences in drainage,ventilator assisted respiration time,hospitalization time,incision length,blood transfusion rate,arrhythmia and pulmonary infection between the two groups at 24 hours after operation(P<0.05).In minimally invasive group,ICU monitoring time,secondary thoracotomy hemostasis,atrial fibrillation heart rate to sinus heart rate,incision infection,pericardial tamponade,low cardiac output syndrome,sepsis,acute renal insufficiency,right diaphragm elevation and liver function were observed in minimally invasive group.Can damage,arrhythmia,residual leakage,technical errors,neurological abnormalities,third degree atrioventricular block,There was no significant difference(P>0.05).During the follow-up of 1 month,3 months,6 months,1 year and 2 years after operation,there was no significant difference in anticoagulation related complications,tricuspid regurgitation,mitral regurgitation and postoperative death between the two groups(P>0.05).Conclusion Minimally invasive right anterolateral thoracotomy is safe and reliable in the treatment of mitral valve disease,and can achieve the same curative effect as traditional median thoracotomy mitral valve surgery,and has less trauma,relatively short hospitalization time,and can play a cosmetic effect.It is worth popularizing in clinic.