Comparison between Minimally Invasive Mitral Valve Replacement via Right Minithoracotomy and Traditional　Mitral Valve Replacement_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Xiao , TAO Liang , CHEN Xufa , YU Huadong , FENG Xueguo , FU Jun.

Departmentof Cardiac Surgery， Wuhan Asia Heart Hospital， Wuhan 430022， P. R. China;

Corresponding author：

Keywords：

Right minithoracotomy; Mitral valve replacement; Safety

DOI：

10. 7507/1007-4848. 20130045

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Objective To compare clinical outcomes and safety between minimally invasive mitral valve replacement via right minithoracotomy （mini-MVR） and traditional mitral valve replacement （MVR）. Methods Clinical data of 68 patients with valvular heart diseases who underwent mini-MVR from February 2009 to December 2011 in Wuhan Asia Heart Hospital were retrospectively analyzed. There were 36 males and 32 females in this mini-MVR group with their mean age of 34.2±11.2 years. Preoperatively， there were 21 patients with mitral stenosis （MS）， 17 patients with mitral insufficiency （MI）， 30 patients with MS and MI， and 19 patients with tricuspid insufficiency （TI）. Another 200 patients with valvular heart diseases who underwent traditional MVR during the same period were included as the control group. There were 86 males and 114 females in the control group with their mean age of 49.4±13.2 years. Preoperatively， there were 85 patients with MS， 66 patients with MI， 49 patients with MS and MI， and 76 patients with TI. Hospital mortality， aortic crossclamp time， length of intensive care unit （ICU） stay， postoperative chest tube drainage， reexploration for bleeding and postoperative morbidities were compared between the two groups. Results There was no in-hospital death in the mini-MVR group. There was no statistical difference in hospital mortality， cardiopulmonary bypass time， incidence of reexploration for bleeding， postoperative arrhythmias， dialysis-requiring acute renal failure and wound infection between the two group （P＞0.05）. Aortic crossclamp time of the mini-MVR group was significantly longer than that of the control group. But postoperative mechanical ventilation time （10.2±3.1 h vs. 15.2±7.1 h， P=0.008）， chest tube drainage（92.0±28.0 ml vs. 205.0±78.0 ml， P=0.000）， blood transfusion （0.8±1.6 U vs. 1.9±2.1 U， P=0.006）， length of ICU stay （14.0±8.0 h vs. 26.0±12.0 h， P=0.003） and length of hospital stay （14.8±4.6 d vs. 19.7±3.2 d， P=0.006）of the　mini-MVR group were significantly shorter or less than those of the control group. Conclusion The safety of mini-MVR is comparable to that of traditional MVR without causing higher postoperative morbidities， while the postoperative recovery　after mini-MVR is better than traditional MVR.

Citation： WANG Xiao,TAO Liang,CHEN Xufa,YU Huadong,FENG Xueguo,FU Jun.. Comparison between Minimally Invasive Mitral Valve Replacement via Right Minithoracotomy and Traditional　Mitral Valve Replacement. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2013, 20(2): 139-143. doi: 10. 7507/1007-4848. 20130045 Copy

1.	Antunes MJ. Minimally invasive valve surgery：reality， dream or utopia ? J Heart Valve Dis， 1998， 7 （4）：358-359.
2.	Gao CQ， Yang M， Wang G， et al. Totally robotic resection of myxoma and atrial septal defect repair. Interact Cardiovasc Thorac Surg， 2008， 7 （6）：947-950.
3.	Casselman FP， Van Slycke S， Dom H， et al. Endoscopic mitral valve repair：feasible， reproducible， and durable. J Thorac CardiovascSurg， 2003， 125 （2）：273-282.
4.	金海，徐志云，于伟勇，等. 微创小切口心脏瓣膜手术134例. 中国胸心血管外科临床杂志， 2005， 12 （4）：237-239.
5.	Jegger D， Tevaearai HT， Mueller XM， et al. Limitations using the vacuum-assist venous drainage technique during cardiopulmonary bypass procedures. J Extra Corpor Technol， 2003， 35 （3）：207-211.
6.	陈振强，赵扬，张辉，等. 胸骨上段小切口径路行心脏瓣膜手术. 中国胸心血管外科临床杂志， 2005， 12 （3）：204-205.
7.	Saunders PC， Grossi EA， Sharony R， et al. Minimally invasive technology for mitral valve surgery via left thoracotomy：experience with forty cases. J Thorac Cardiovasc Surg， 2004， 127 （4）：1026-1031.
8.	Cheng YG， Wang YJ， Wang WJ， et al. Totally endoscopic atrial-septal defect repair through 3 ports. Heart Surg Forum， 2008， 11 （5）：e285-e289.
9.	Soltesz EG， Cohn LH. Minimally invasive valve surgery. Cardiol Rev， 2007， 15 （3）：109-115.
10.	王延震，赵璐洋，甘义荣. 右胸前外侧切口不阻断升主动脉二尖瓣置换27例. 中国心血管病研究， 2008， 6 （9）：652-653.
11.	Walther T， Falk V， Friedrich WM. Minimally invasive surgery for valve disease. Curr Probl Cardiol， 2006， 31 （6）：399-437.
12.	Lee S， Chang BC， Lim SH， et al. Clinical results of minimally invasive open-heart surgery in patients with mitral valve disease：comparison of parasternal and low-sternal approach. Yonsei Med J， 2006， 47 （2）：230-236.
13.	Sharony RP. Minimally invasive reoperative isolated valve surgery：early and mid-term results. J Card Surg， 2006， 2l （3）：240-244.
14.	Gao CQ， Yang M， Wang G， et al. Excision of atrial myxoma using　robotic technology. J Thorac Cardiovasc Surg， 2010， 139 （5）：1282-1285.
15.	Grossi EA， Galloway AC， Lapietra A， et al. Minimally invasive mitral valve surgery：a 6-year experience with 714 patients. Ann Thorac Surg， 2002， 74 （3）：660-663.
16.	Modi P， Rodriguez E， Hargrove WC 3rd， et al. Minimally invasive video-assisted mitral valve surgery：a 12-year， 2-center experience in 1178 patients. J Thorac Cardiovasc Surg， 2009， 137 （6）：1481-1487.
17.	Aybek T， Dogan S， Risteski PS， et al. Two hundred forty minimally　nvasive mitral operations through right minithoracotomy. Ann Thorac　Surg， 2006， 81 （5）：1618-1624.
18.	陈和明，刘立明. 胡建国右胸前外侧小切口微创二尖瓣置换术. 中南大学学报， 2010， 35 （9）：1005-1008.
19.	Lapenna E， De Bonis M， Torracca L， et al. Cavernous hemangioma of the tricuspid valve：minimally invasive surgical resection. Ann Thorac Surg， 2003， 76 （6）：2097-2099.
20.	Goldstein DJ， Oz MC， Chief Editor. Minimally Invasive Cardiac Sugery. 2nd ed. Beijing：People’s Medical Publishing House， 2007.225-240.
21.	陈海生，冼明海，程云阁，等. 经股动静脉插管建立体外循环行电视胸腔镜与心内直视手术138例. 中国胸心血管外科临床杂志， 2005， 12 （5）：361-362.
22.	Martens S， Dietrich M， Doss M， et al. Optimal Carbon dioxide　application for organ protection in cardiac surgery. J Thorac Cardiovasc　Surg， 2002， 124 （2）：387-391.
23.	Lutter G， Ardehali R， Cremer J， et al. Percutaneous valve replacement：current state and future prospects. Ann Thorac Surg， 2004， 78 （6）：2199-2206.
24.	罗春生，张石江，景华，等. 右胸前外侧切口行二尖瓣置换术. 中国胸心血管外科临床杂志， 2005， 12 （2）：120-121.
25.	Casselman FP， La Meir M， Jeanmart H， et al. Endoscopic mitral and tricuspid valve surgery after previous cardiac surgery. Circulation，2007， 116 （11 Suppl）：I270-I275.
26.	肖明第，程云阁. 微创心脏瓣膜外科的现状与未来. 中国微创外科杂志， 2010， 10 （2）：99-100.
27.	Shinfeld A， Shimin Y， Priesman S， et al. Minimally invasive video-assisted mitral valve repair or replacement. Harefush， 2007， 146 （11）：837-840.
28.	Seeburger J， Borger MA， Falk V， et al. Minimally invasive mitral valve surgery after previous sternotomy：experience in 181 patients. Ann Thorac Surg， 2009， 87 （3）：709-714.

1. 　Antunes MJ. Minimally invasive valve surgery：reality， dream or utopia ? J Heart Valve Dis， 1998， 7 （4）：358-359.
2. 　Gao CQ， Yang M， Wang G， et al. Totally robotic resection of myxoma and atrial septal defect repair. Interact Cardiovasc Thorac Surg， 2008， 7 （6）：947-950.
3. 　Casselman FP， Van Slycke S， Dom H， et al. Endoscopic mitral valve repair：feasible， reproducible， and durable. J Thorac CardiovascSurg， 2003， 125 （2）：273-282.
4. 　金海，徐志云，于伟勇，等. 微创小切口心脏瓣膜手术134例. 中国胸心血管外科临床杂志， 2005， 12 （4）：237-239.
5. 　Jegger D， Tevaearai HT， Mueller XM， et al. Limitations using the vacuum-assist venous drainage technique during cardiopulmonary bypass procedures. J Extra Corpor Technol， 2003， 35 （3）：207-211.
6. 　陈振强，赵扬，张辉，等. 胸骨上段小切口径路行心脏瓣膜手术. 中国胸心血管外科临床杂志， 2005， 12 （3）：204-205.
7. 　Saunders PC， Grossi EA， Sharony R， et al. Minimally invasive technology for mitral valve surgery via left thoracotomy：experience with forty cases. J Thorac Cardiovasc Surg， 2004， 127 （4）：1026-1031.
8. 　Cheng YG， Wang YJ， Wang WJ， et al. Totally endoscopic atrial-septal defect repair through 3 ports. Heart Surg Forum， 2008， 11 （5）：e285-e289.
9. 　Soltesz EG， Cohn LH. Minimally invasive valve surgery. Cardiol Rev， 2007， 15 （3）：109-115.
10. 　王延震，赵璐洋，甘义荣. 右胸前外侧切口不阻断升主动脉二尖瓣置换27例. 中国心血管病研究， 2008， 6 （9）：652-653.
11. 　Walther T， Falk V， Friedrich WM. Minimally invasive surgery for valve disease. Curr Probl Cardiol， 2006， 31 （6）：399-437.
12. 　Lee S， Chang BC， Lim SH， et al. Clinical results of minimally invasive open-heart surgery in patients with mitral valve disease：comparison of parasternal and low-sternal approach. Yonsei Med J， 2006， 47 （2）：230-236.
13. 　Sharony RP. Minimally invasive reoperative isolated valve surgery：early and mid-term results. J Card Surg， 2006， 2l （3）：240-244.
14. 　Gao CQ， Yang M， Wang G， et al. Excision of atrial myxoma using　robotic technology. J Thorac Cardiovasc Surg， 2010， 139 （5）：1282-1285.
15. 　Grossi EA， Galloway AC， Lapietra A， et al. Minimally invasive mitral valve surgery：a 6-year experience with 714 patients. Ann Thorac Surg， 2002， 74 （3）：660-663.
16. 　Modi P， Rodriguez E， Hargrove WC 3rd， et al. Minimally invasive video-assisted mitral valve surgery：a 12-year， 2-center experience in 1178 patients. J Thorac Cardiovasc Surg， 2009， 137 （6）：1481-1487.
17. 　Aybek T， Dogan S， Risteski PS， et al. Two hundred forty minimally　nvasive mitral operations through right minithoracotomy. Ann Thorac　Surg， 2006， 81 （5）：1618-1624.
18. 　陈和明，刘立明. 胡建国右胸前外侧小切口微创二尖瓣置换术. 中南大学学报， 2010， 35 （9）：1005-1008.
19. 　Lapenna E， De Bonis M， Torracca L， et al. Cavernous hemangioma of the tricuspid valve：minimally invasive surgical resection. Ann Thorac Surg， 2003， 76 （6）：2097-2099.
20. 　Goldstein DJ， Oz MC， Chief Editor. Minimally Invasive Cardiac Sugery. 2nd ed. Beijing：People’s Medical Publishing House， 2007.225-240.
21. 　陈海生，冼明海，程云阁，等. 经股动静脉插管建立体外循环行电视胸腔镜与心内直视手术138例. 中国胸心血管外科临床杂志， 2005， 12 （5）：361-362.
22. 　Martens S， Dietrich M， Doss M， et al. Optimal Carbon dioxide　application for organ protection in cardiac surgery. J Thorac Cardiovasc　Surg， 2002， 124 （2）：387-391.
23. 　Lutter G， Ardehali R， Cremer J， et al. Percutaneous valve replacement：current state and future prospects. Ann Thorac Surg， 2004， 78 （6）：2199-2206.
24. 　罗春生，张石江，景华，等. 右胸前外侧切口行二尖瓣置换术. 中国胸心血管外科临床杂志， 2005， 12 （2）：120-121.
25. 　Casselman FP， La Meir M， Jeanmart H， et al. Endoscopic mitral and tricuspid valve surgery after previous cardiac surgery. Circulation，2007， 116 （11 Suppl）：I270-I275.
26. 　肖明第，程云阁. 微创心脏瓣膜外科的现状与未来. 中国微创外科杂志， 2010， 10 （2）：99-100.
27. 　Shinfeld A， Shimin Y， Priesman S， et al. Minimally invasive video-assisted mitral valve repair or replacement. Harefush， 2007， 146 （11）：837-840.
28. 　Seeburger J， Borger MA， Falk V， et al. Minimally invasive mitral valve surgery after previous sternotomy：experience in 181 patients. Ann Thorac Surg， 2009， 87 （3）：709-714.

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Comparison between Minimally Invasive Mitral Valve Replacement via Right Minithoracotomy and Traditional　Mitral Valve Replacement

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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Comparison between Minimally Invasive Mitral Valve Replacement via Right Minithoracotomy and Traditional Mitral Valve Replacement

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Comparison between Minimally Invasive Mitral Valve Replacement via Right Minithoracotomy and Traditional　Mitral Valve Replacement