Comparison Of Curative Effects As Well As Mid- And Long-term Follow-up Results Of Robotic And Sternotomy Mitral Valve Replacement

Objective:(1) To summarize and analyse the clinical experience of totally endoscopic Robotic Mitral Valve Replacement(TE-MVR) for treating valvular heart disease in the PL A General Hospital by studying Clinical data of TE-MVR and patients’ follow-up for recovery. (2) To evaluate the effectiveness, safety and postoperative quality of life by comparing the clinical data and postoperative follow-up of TE-MVR and sternotomy MVR, which in order to provide reasonable clinical guide for the patients.Methods:(1)we retrospectively involved 47 patients’ clinical data who received TE-MVR in the PLA General Hospital ranging from January,2007 to December,2015. We analysed the efficiency of MVR and postoperative effects in the near future by following up and collecting transthoracic echocardiography (TTE) data. Simultaneously, the learning curve was drawn by comparing the changes of cardiopulmonary bypass time (CPB) and aortic cross-clamping time on the base of accumulation of operation.(2) 47 patients in part one were selected as the TE-MVR group. Another 47 patients who received Conventional Sternotomy MVR were selected as CS-MVR group, which corresponded with the principle of 1 to 1 in match with TE-MVR group. The matching indicators were as follows:preoperative NYHA classes (New York Heart Association classes), types and degrees of lesions, preoperative Euro-Score II scoring, LVEF, age, gender and types of prosthetic valve. We compared TTE and NYHA classes and evaluate changes of the heart function by collecting perioperative and postoperative follow-up data. Besides, we conducted the SF-12(QOL) health survey to analyze the quality of life in 30 days and 6 months after operation, respectively.Result:(1)All TE-MVR were conducted successfully and there was only one case having postoperative complication (2.12%), which was pleural effusion and cured after thoracic close drainage. TTE results before discharge in TE-MVR group were satisfying and there were no paravalvular leakage, left ventricular outflow tract obstruction or prosthetic valve dysfunction. All patients in TE-MVR group were discharged successfully. And 41 patients kept contact during the long-term follow-up (6-88 months), most of whose heart function were NYHA class I and II. Postoperative TTE indicated that the left atrial diameter decreased (P<0.05), while the left ventricular end-diastolic diameter and ejection fraction did not change significantly. The CPB and aortic cross-clamping time of TE-MVR group corresponded with the learning curve which decreased gradually with the increasing the number of operations.(2)The baseline data of both groups were similar and comparable. Perioperative blood product infusion, postoperative drainage volume, ICU stay and intubation time in TE-MVR group were obviously less than those in CS-MVR group, and the differences were statistically significant (P<0.05). There was no death during operation in both groups. The differences of complications between two groups weren’t statistically significant. The average CPB time (122.02±25.45min) and cross-clamping time (85.68±20.70min) were significantly longer in TE-MVR group than those in CS-MVR group(P<0.001).The average score of SF-12 in 30 days after operation was higher in TE-MVR group than that in CS-MVR group. There were no significant differences between two groups in quality of life questionnaire in 6 months after operation. Heart function in TE-MVR group improved significantly depending on follow-up of TTE and NYHA class in 1 to 5 years.Conclusion:TE-MVR is feasible, effective and safe, of which postoperative follow-up presented great heart function. TE-MVR will benefit patients more, such as smaller trauma, faster recovery, higher quality of life and better wound recovery, and it remains to be a great minimally invasive alternative while there are no sifinicant advantages on mid to long term compared with CS-MVR.