A Comparative Study Of Mitral Valve Replacement By Right 3rd Intercostal Small Incisionand Traditional Median Thoracotomy

Objective:To compare the safety and efficacy of simple mitral valve replacement through minimally invasive right third intercostal small incision and conventional median sternal incision.Methods: Retrospective analysis of the patients with mitral valve disease admitted to our hospital from February 2017 to October 2019 was carried out.A total of 143 patients with the first simple mitral valve replacement were selected,including 59 patients with the third right intercostal minimally invasive incision(minimally invasive operation group),20 males and 39 females,with an average age of 59.51 years;84 patients with the conventional median sternal incision(conventional operation group),32 males and 52 females The average age was 60.22 years old.Types of lesions: 85 cases of mitral stenosis,38 cases of insufficiency of closure,20 cases of stenosis with insufficiency of closure.The preoperative indexes,operation time,aortic occlusion time,operation time,ICU time,24-hour thoracic drainage volume and postoperative complications were analyzed and compared between the two groups.Results: There was no significant difference between the two groups(P > 0.05).All the patients completed the operation successfully.94 cases of mechanical mitral valve and 49 cases of biological valve were replaced.There was no significant difference in the time of cardiopulmonary bypass,aortic occlusion and total hospitalization between the minimally invasive operation group and the conventional operation group(P > 0.05),but the time of staying in ICU after operation was significantly shorter than that of the conventional operation group.5 cases were treated with secondary hemostasis after early thoracotomy,1 case was treated with minimally invasive operation,the other 4 cases were treated with routine operation.Three cases of incision infection were in the routine operation group.Three patients died in the early postoperative period in the whole group,all of them were in the routine operation group,two patients were in the low cardiac output syndrome leading to multiple organ failure,the other one was in the sternum infection complicated with artificial valve endocarditis.Conclusion: The third intercostal mitral valve replacement in the right chest has no significant difference with the traditional mitral valve replacement in terms of safety and does not increase the incidence of postoperative complications.However,compared with the traditional median thoracotomy,it has the advantages of less surgical trauma,less postoperative incision infection and less postoperative pain.