The Clinical Study Of Mitral Valve Surgery Through A Right Anterolateral Minimal Incision

Objective This study is to evaluate the safety, validity and postoperative lung function of mitral valve surgery through a minimal anterolateral incision of right chest wall by the comparison of classic mitral valve surgery through the mid-line sternotomy.Methods From October 2009 to May 2010, fifty consecutive adult patients with the indication of mitral valve replacement or mitral valve repairment were involved into this study. They were randomly divided into a control group(n=26) and a minimal incision group(n=24). Patients in the minimal incision group were operated through a minimal anrerolateral incision of right chest wall with a length of 5 to 7 centimetre(18 cases had mitral valve replacement and 6 cases had mitral valve repairment, among them 2 cases are accompanied with tricuspid valve plasty and 2 cases are accompanied with thrombectomy of left atrium) while their counterpart were operated through the classic mid-line sternotomy(16 cases had mitral valve replacement and 10 cases had mitral valve repairment).We compared the time spent to establish cardiopulmonary bypass (from the beginning of operation to the beginning of cardiopulmonary bypass), the duration of cardiopulmonary bypass, the time of aortic cross-clamp, the time of postoperative ventilatory support,the time of staying in the intensive care unit, the volume of blood transfusion, the volume of thoracic drainage, the length of incision and the days from operation to the patients' leaving hospital.We also monitored and compared the respiratory index (RI) at the following different time points:preoperation,15 minutes, 1 hour and 4 hours after the termination of cardiopulmonary bypass.Results 1.There were no significant difference on such index as the time spent to establish cardiopulmonary bypass, the duration of cardiopulmonary bypass, the time of aortic cross-clamp,the time of staying in the intensive care unit (p>0.05),but the duration of operation lasts and mechanical ventilatory support of the minimal incision group was shorter than that of the control group (p<0.05),and at the meanwhile patients of the minimal incision group suffered less volume of thoracic drainage, shorter length of incision (p<0.05) and fewer days form operation to their leaving hospital than patients of of the control group (p<0.05).2.The diameter of left atrium and left ventricle reduced after operation in both group (p<0.05), but the gap between postoperative and preoperative diameter has no significant difference in the two groups (p>0.05).3.The respiratory index was worse preserved at the time point of 15 minutes after termination of cardiopulmonary bypass in the minimal incision group than in the control group (p<0.05),but at other time points there was no significant difference between the two groups.Conclusion 1.Mitral valve surgery through a minimal anterolateral of right chest wall possesses same safety and validity as classic mitral valve surgery through the mid-line sternotomy.2.Cardiopulmonary bypass could obviously reduce the lung function.3.Compared with the classic mitral valve operation, minimal incision operation decreases the trauma and promotes the postoperative recovery.