| Background: The mitral regurgitation(MR)is one of the most common pathophysiological changes of mitral valve.Heart diseases which complicated with MR are really common,such as dilated cardiomyopathy,rheumatic heart disease(RHD),mitral valve prolapse,degenerative mitral valve disease,thoracic injury,infective endocarditis(IE),ischemic cardiomyopathy,etc.The most recommended therapy of treating MR is the mitral valve repair(MVP).With the fast development of minimally invasive cardiac surgery,minimally MVP has also been invented,and the video-assisted(VSTD)MVP through right minithoracotomy(RMT)is one of the most mature surgery between them.Objective: To share the experience of treating 3 cases of VSTDMVP through RMT,evaluating perioperative effect and short-term outcomes.Method: We performed a retrospective analysis between January 1st 2017 and January 1st 2018 of 15 patients who were treated by VSTDMVP through RMT in our hospital.There were 6 males and 9 females with age of 29~61,the average age was 45±10.1 years old.Six patients was diagnosed as mitral valve prolapse,four patients were diagnosed as RHD,another four patients were diagnosed as degenerative mitral valve disease,and one patient was diagnosedas IE before the surgery.5 of them was complicated with hyper-tension,3 of them was complicated with atrial fibrillation,and 2 of them was complicated with left atrial thrombosis.All of the patients taked an echocar-diography examination before the operation,and were diagnosed as complicat-ing with MR.The regurgitation of the mitral valve was 9.65±3.30 cm2.All of the surgery were performed with arresting heart and on-pump,choosing the right internal jugular vein,the right femoral artery and the right femoral vein to esta-blish the cardiopulmonary bypass.A right anterolateral incision at the fourth intercostal space was used as the main incision in male patients.An arc-shaped incision at the lower margin of the right breast was used as the main incision in female patients.Two incisions at the third and fifth intercostal space along right midaxillary line were used as auxiliary incisions to pass the thoracoscope,the infusion cannula,and the aorta clamp forcep.Perform the MVP via interatrial groove approach with the assist of transthoracic echocardiographyResult: All the patients survived the operation.There was no operation changing into median sternotomy and valve replacement.The average operating room time was 254.27±45.21 minutes;average cardiopulmonary bypass time was 169±39.6 minutes,average aorta clamping time was 115.8±34.92 minutes.The valve dysfunctions were mainly type ? and type ? b of Carpentier's classification.8 patients underwent leaflet resection,1 patient underwent leaflet reconstruction using pericardial tissue,10 patients underwent artificial chordae implantation,and 15 patients underwent prosthetic ring implantation.Average operative bleeding was 177.33±81.68 ml.8 patients underwent blood transfusion during the operation,the blood transfusing rate was 53.3%.Average ventilator assisted breathing time was 18.43±5.13 hours.Average in-ICU stay was23.67±4.98 hours.Average in-hospital stay was 7.93±0.85 days.Patients werefollowed up for 3 months to 24 months.No patient died and only 3 patients were still complicated with mitral regurgitation less than 3cm2 during the follow-up period.The median follow-up time was 12 months(8.5,18.5).Conclusion: 1.The video-assisted mitral valve repair through right mini-thoracotomy is a safe and efficacious treatment;2.Comparing with median sternotomy,the RMT has a lower incidence of complications,but we should be attention to avoiding the special complications of RMT heart surgery;3.This surgery is difficult.It involves many professional territories and requires long-term learning.A good collaboration of surgical team is the key-point of increasing efficiency of the operation. |
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