Analysis Of The Efficiency Of Totally Thoracoscopic Surgery For Mitral Valve Disease Complicated With Atrial Fibrillation

Objective:In recent years,minimally invasive totally thoracoscopic technique has been used safely and widely in the treatment of some diseases in cardiac surgery,especially in cardiac valve surgery.Mitral valve disease with atrial fibrillation is common,and it is difficult to cure atrial fibrillation by mitral valve surgery.Therefore,how to cure the mitral valve disease while treating atrial fibrillation has become a hot and difficult problem in totally thoracoscopic surgery.This study aims to summarize the surgical experience in the treatment of mitral valve disease complicated with atrial fibrillation by totally thoracoscopic technology in our hospital,compare the safety and effectiveness of mitral valve surgery combined with radiofrequency ablation for atrial fibrillation by totally thoracoscopic surgery and traditional median sternotomy surgery,and analyze the recent efficiency of totally thoracoscopic surgery.Materials and Methods: A total of 102 patients who underwent mitral valve surgery with radiofrequency ablation for atrial fibrillation at our hospital between January 2020 and December 2020 were retrospectively analyzed.These 102 patients were performed surgery using either totally thoracoscopic surgery or median sternotomy.All patients were divided into thoracoscopy group and sternotomy group according to the different surgical methods.In thoracoscopy group,there were 45 patients(26 males,19 females)received totally thoracoscopic mitral valve surgery with radiofrequency ablation for atrial fibrillation.The age was(55.86±10.58)years old and the duration of atrial fibrillation was(23.91±8.13)months.In sternotomy group,there were 57 patients(27 males,30 females)received median sternotomy mitral valve surgery with radiofrequency ablation for atrial fibrillation.The age was(56.70±8.95)years old and duration of atrial fibrillation was(25.62±8.07)months.Recording to the related index data and cases in course of hospitalization and surgery in two groups,analyzing and comparing the collected data.Results:In thoracoscopy group,the mechanical ventilation time was(13.83±6.39)h,the ICU time was(19.12±10.67)h,and the hospitalization time was(10.13±4.54)d.In sternotomy group,the mechanical ventilation time was(17.45±8.64)h,the ICU time was(25.59±13.85)h,and the hospitalization time was(12.81±5.79)d.Compared with the sternotomy group,the postoperative mechanical ventilation time(P=0.021),ICU time(P=0.011)and the hospitalization time(P=0.012)in thoracoscopy group were significantly shorter;In thoracoscopy group,the 24 h drainage fluid was(70.04±35.78)ml,and the total drainage drainage fluid was(147.38±75.95)ml.In sternotomy group,the 24 h drainage fluid was(251.22±99.12)ml,and the total drainage drainage fluid was(683.64±163.26)ml.Compared with the sternotomy group,the 24 h drainage fluid and total drainage drainage fluid in thoracoscopy group were significantly decreased(P<0.001);In thoracoscopy group,5 cases of postoperative pulmonary infection,0 case of wound infection.In sternotomy group,16 cases of postoperative pulmonary infection,5 cases of wound infection.Compared with the sternotomy group,the incidence of postoperative pulmonary infection(P=0.036)and wound infection(P=0.043)were significantly lower in thoracoscopy group,and there was no statistical difference in the incidence of other postoperative complications(P>0.05);The wound length in thoracoscopy group was(8.97±2.02)cm,while that in sternotomy group was(22.61±3.13)cm.The wound length in thoracoscopy group was significantly shorter than that in sternotomy group(P<0.001);In thoracoscopy group,there were 36 cases of sinus rhythm,5 cases of atrial fibrillation and 4 cases of atrial flutter after surgery,the rate of atrial fibrillation recovery was 80%.In sternotomy group,there were 45 cases of sinus rhythm,7 cases of atrial fibrillation and 5 cases of atrial flutter after surgery,the rate of atrial fibrillation recovery was 79%.The conversion of atrial fibrillation was satisfactory,and there was no statistical difference in two groups(P=0.984);There were no significant differences in operative time,postoperative cardiac function and echocardiographic indicators between two groups(P>0.05).Conclusion:Using totally thoracoscopic technique and traditional median sternotomy in mitral valve surgery with radiofrequency ablation for atrial fibrillation can achieve satisfactory recent efficiency.Comparing with the midline sternotomy sugery,totally thoracoscopic surgery for mitral valve disease complicated with atrial fibrillation can significantly reduce the postoperative drainage volume,decrease the incidence of postoperative pulmonary infection and wound infection,shorten ICU time and hospitalization time,speed the postoperative recovery,improve patient’s satisfaction,and it is a safe and effective surgery.