| BACKGROUND:Mitral valve disease, as one of the heart disease, is very common in China, accounting for50%-70%of the cardiac valve disease. The main causes of mitral valve disease are rheumatic fever, mucoid degeneration, degenerative changes, necrosis, infection, and trauma. All these pathological changes lead to valve structural change, and functional abnormalities, thus affect the stability of cardiac hemodynamic, and ultimately can lead to heart failure. From the viewpoint of the patient, clinically relevant mitral valve disease is associated with discomfort due to the need for surgical repair.The surgical treatments for critical mitral valve disease are mitral valve replacement (MVR) and mitral valvuloplasty (MVP). Median sternotomy as the classical golden standard has been widely used in clinical. With the progress of science and technology, minimally invasive mitral valve surgery began gradually applied to clinical in the1990s. Because of the fewer traumas, faster postoperative recovery, excellent cosmetic effect, and short hospitalization time, minimally invasive mitral valve surgery have rapidly developed into a standard operation, and gained more and more clinical acceptance. OBJECTIVES:Minimally invasive mitral valve surgery, as a new technique, has been widely used for years. Many studies have reported that patients undergone this operation can get satisfactory clinical effect and maintain the same high quality of operation afforded by traditional open techniques. By compare the clinical effect of minimally invasive mitral valve surgery with the median thoracotomy mitral valve surgery, we aim to analyse the clinical experience and key points of the minimally invasive mitral valve surgery, and make an objective evaluation on it.MATERIALS AND METHODS:Between August2010to March2012,64cases of patients, who were under70years old, needed to undertake a mitral valve surgery, NYHA class Ⅱ-Ⅳ and no history of cardiothoracic surgery, were selected in this study. Patients with aortic valve disease were excluded. They were divided into minimally invasive incision group(21cases) and median thoracotomy group(43cases). The patients who were elder than50should undertake the coronary an-giography to eliminate the coronary artery disease. After operation, the data such as the cardiopulmonary bypass time, aortic cross-clamp time, heart automatic resuscitation rate, intraoperative blood transfusion, mechanical ventilation time, CK-MB increased value, postoperative drainage volume, postoperative pain and hospital stay were collected, and analyzed on the comparison.RESULTS:All the operations were successful, without hospital mortality in either group. All the patients did not have the secondary thoracotomy hemostasis. The respiratory and central nervous system complications were not observed.Compare the minimally invasive group with the conventional median sternotomy group, there were no obvious differences in CPB time, automatic resuscitation rate, and aortic cross-clamping time(P> 0.05); but the operation time, the blood transfusion, the post-operative drainage volume, and the CK-MB increased value on first post operative day of the minimally invasive group were less than the conventional median sternotomy group (P<0.01); the mechanical ventilation time and the postoperative hospital stay of minimally invasive group were shorter(P<0.01).On the fifth post operative day, the patients were assessed for pain with use of the Wong-Baker pain classification grades. The grades of the minimally invasive group were obvious lower than the con-ventional median sternotomy group(P<0.01).No paravalvular leakage in patients undertaken mitral valve replacement and no/less regurgitmion in patients undertaken mitral valvuloplasty were observed by echocardiography at1week after operation. Patients in two groups were followed up for2to17months. The patient’s symptoms have significantly improved, and no post-operative complications occurred. Patients were satisfied with quick recovery and the excellent cosmetic effect.CONCLUSIONS:The minimally invasive heart valve surgery is safety and reliable, with less trauma, less blood transfusion, good cosmetic results and similarly clinical results compared with the median stemotomy surgery. All of these benefits will translate into improved utilization of the limited healthcare resources, and patients will adopt the minimally invasive approach for routine mitral valve surgery. |
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