Comparative Analysis Of Perioperative Indexes Of Different Methods Of Mitral Valve Replacement

Objective: To compare the perioperative indicators of the median chest incision,thoracoscopy assisted small incision and totally thoracoscopic mitral valve replacement,the advantages and disadvantages of different methods of mitral valve replacement were studied.Provide more information for the clinical application of totally thoracoscopic surgery.Methods: The patients who underwent mitral valve replacement in the Department of Thoracic and Cardiovascular Surgery of the People’s Hospital of Guangxi Zhuang Autonomous Region from June 2016 to June 2019 were used as the research objects for analysis.According to the continuous method,60 patients were divided into 3 groups with 20 cases in each group.Group A: totally thoracoscopic mitral valve replacement;Group B:Thoracoscopy assisted small incision for mitral valve replacement;Group C: Median thoracotomy for mitral valve replacement.For the three groups of patients,the gender,age,preoperative weight,cardiac function New York Heart Association(NYHA)classification,left ventricular ejection fractions(LVEF),operation time,cardiopulmonary bypass time,ascending aortic occlusion time,intraoperative blood loss,intraoperative blood transfusion(red blood cells,plasma),Postoperative ventilator-assisted breathing time,ICU staying time,thoracic drainage volume,postoperative blood transfusion(red blood cells,plasma),postoperative hospitalization days,postoperative complications,total hospitalization costs,and short-term follow-up relevant clinical data were analyzed statistically.Analyze and summarize the reasons for the differences in the three sets of data.Results: The gender,age,preoperative weight,Cardiac function NYHA classification and LVEF baseline of the three groups were the same.The operation time,cardiopulmonarybypass time,and ascending aorta occlusion time of the median thoracotomy group were less than that of the thoracoscopy assisted small incision group and the totally thoracoscopic group(P<0.05).In terms of postoperative hospitalization days,thoracic drainage volume,postoperative blood transfusion and other indicators,the totally thoracoscopic group had advantages compared with the thoracoscopy assisted small incision group and the median thoracotomy group,and the difference was statistically significant(P<0.05).There was no significant difference in the amount of intraoperative blood loss,intraoperative blood transfusion,ventilator-assisted breathing time,ICU staying time,postoperative complication rate,and total hospitalization costs.Postoperative pain and satisfaction with the incision were the best in the totally thoracoscopic group,followed by the thoracoscopy assisted small incision group,and the worst in the median thoracotomy group.As of September 2019,the follow-up period ranged from 3-39 months to 58 patients,with a follow-up rate of 96.7%.The three groups of patients were in a good state of life,and there were no serious postoperative complications such as out-of-hospital death,cerebral embolism,cerebral hemorrhage,mechanical valve failure,paravalvular leakage,and hemolysis.Conclusion: Three surgical methods of total thoracoscopy,thoracoscopy assisted small incision and median thoracotomy for mitral valve replacement are safe and effective clinical treatment methods.while the totally thoracoscopic mitral valve replacement surgery has minimal chest wall trauma,less bleeding,quick recovery,fewer complications,better cosmetic effects and better patient experience.Thoracoscopy assisted small incision is a minimally invasive surgical method and can also be used as a transitional operation method to master total thoracic surgery.