| Totally thoracoscopic cardiac surgery means doing the operation completely with thoracoscopy.Over the past 20 years,with the rapid development and refinement of the cardiopulmonary bypass technology and surgical instruments,the mitral valve replacement has gradually evolved from conventional median sternotomy towards totally thoracoscopic approach.For many patients,totally thoracoscopic surgery for mitral valve replacement has evolved into a safe and efficient surgery with similar perioperative morbidity and mortality rates compared with conventional median sternotomy,what's more,patients derive a variety of tangible benefits from this totally thoracoscopic approache,including reducing surgical trauma,lower costs,less pain,shorter lengths of postoperative stay,and faster return to preoperative functional levels.Nowadays,the totally thoracoscopic mitral valve replacement has become into a routinely performed case in many institutions.Between 2012 and 2016,a total of 20 patients with mitral valve disease underwent totally thoracoscopic mitral valve replacement at the department of cardiac surgery of our hospital.The purpose of this study is to compare the results of the two methods and to report our overall experience with totally thoracoscopic mitral valve replacement.Objective: Compare the clinical outcomes of mitral valve replacement with access by sternotomy and totally thoracoscopic approach,and evaluate the advantages and clinical value of totally thoracoscopic mitral valve replacement.Methods: Totally 20 patients underwent mitral valve replacement by totally thoracoscopic approach were the TT group.Age,gender,left ventricular ejection fraction,types of mitral valve diseases and BMI wereselected as the matching factors.According to the principle of category matching,20 cases underwent mitral valve replacement during the same period by conventional sternotomy approach were the CS group.Analyse these clinical outcomes of 40 patients undergoing mitral valve replacement by median sternotomy or totally thoracoscopic approach,with th emphasis on the comparisons of time of operation,cardiopulmonary bypass,aortic clamp,and mechanical ventilation,length of stay in intensive care unit,volume of total chest drainage,duration of urinary catheter,proportion of patients who used opioid analgesics such as pethidine or morphine for pain medication,length of postoperative stay.All the patients were followed after 6 months postoperatively for evaluating the condition of mitral valve regurgitation under echocardiography.A P value below 0.05 was considered statistically significantly in all these test.Results: Compared to the CS group,the TT group had significantly longer time of operation(250.1±7.5min vs.225.4±9.1min P < 0.001),cardiopulmonary bypass time(113.1±6.4min vs.84.1±4.6min P < 0.001),aortic clamp time(85.2±3.1min vs.59.8±2.2min P<0.001).Compared to the CS group,the TT group had significantly longer time of mechanical ventilation(12.5±0.8h vs.11.0±0.7h P<0.001).The patients in the TT group had significantly shorter stay in the intensive care unit following surgery(38.2±1.5h)than those in the CS group(44.0±1.8h P<0.001).In addition,the mean length of postoperative stay was shorter in TT group(8.0±0.8d),compared to the CS group(9.4±0.9d P<0.001).The mean volume of total chest drainage of was significantly less in the TT group(366.5±29.8ml)than for the CS group(499.9±29.5ml P<0.001).The removal of urinary catheter was significantly earlier in the TT group(3.7±0.7d),compared to the CS group(4.4±0.5d P=0.02).The proportion of patients who used opioid analgesics such as pethidine or morphine for pain medication in the TT group was significantly less(20%)compared to the CS group(60% P=0.007).There was no death happened in both group,all the patients were recovered smoothly,during follow-ups at 6 months no prosthesis dysfunctionwas found,and there was no significant difference on EF between the two group.Conclusions: Compared with the CS group,the totally thoracoscopic mitral valve replacement was safe and feasible,it also provided a smaller trauma,faster restoration and shorter time in hospital.Meanwhile,the total thoracoscopic approach led to better cosmetic effect. |
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