Comparison Effects Of Mitral Valvuloplasty Via Totally Thoracoscopic Versus Traditional Median Sternotomy

Objectives:By analyzing the data of patients undergoing totally thoracoscopic mitral valvuloplasty and traditional median sternotomy mitral valvuloplasty,summarizing and analyzing the surgical effects of mitral valvuloplasty in our center,and further exploring the efficacy and safety of totally thoracoscopic mitral valvuloplasty,thus providing a stronger basis for patients to choose the best treatment.Methods:A total of 1221 patients undergoing mitral valvuloplasty from January 2015 to August 2018 in our hospital were analyzed retrospectively.They were divided into the study group(n=654),which received mitral valvuloplasty via the totally thoracoscopic approach,and the control group(n=567),which received mitral valvuloplasty via traditional median sternotomy approach,and use the propensity score matching method for pairing.Before and after matching,Clinical data,surgical results,and clinical outcomes in the two groups were comparatively analyzed.Results:The mean age of 1221 patients was 47.2±15.1 years.And there was no significant difference in preoperative general data in the two groups.Before and after the propensity score matching,cardiopulmonary bypass time and aortic cross-clamping time in the study group were longer than those in the control group(P<0.05).Operation time in the study group were shorter than those in the control group before matching(227.41±55.3 min vs 238.1±56.4 min,P<0.05).And after matching,there was no significant difference in operation time between the two groups(P>0.05).Before and after matching,there was no significant difference in the incidence rate of secondary cross-clamping and mitral valve replacement in the two groups(P>0.05).In the blood transfusion rate and the incidence rate of respiratory tract infection and postoperative poor wound healing,the study group were lower.After matching,they were 12.8%vs.22.3%;1.4%vs 16.1%;1.4%vs 5.5%(all P<0.05).And the postoperative hospitalization duration was shorter in the study group,which were(6.1±4.4)d vs(13.3±10.6)d after matching(P<0.05).Before and after matching,there was no significant difference in hospitalization costs in the two groups(P>0.05).Within 30 days after surgery,1 patient died in the study group and 4 patients died in the control group.There was no significant difference in mortality within 30 days after surgery between the two groups(P>0.05).Before discharge,there were 4 and 5 cases of severe mitral valve regurgitation,respectively.No matter before or after matching,there was no significant difference between the two groups(P>0.05).The mean time of followed up was(34.9±13.0)months.During follow-up,there were 9 and 21 cases of severe mitral valve regurgitation,4 and 2 cases of re-surgery,and 10 and 4 cases of death in the study group and control group,respectively.The incidence of severe mitral valve regurgitation in the study group was lower than that in the control group in the near and medium term,which were 1.2%vs 3.1%after matching(P<0.05).Before and after matching,there was no significant difference in the rate of re-surgery and mortality between the two groups in the near and medium term(P>0.05).Conclusions:Compared with mitral valvuloplasty via traditional median stemotomy,minimally-invasive mitral valvuloplasty is superior in shortening postoperative hospitalization duration,decreasing blood transfusion rate,and reducing postoperative complications.It can achieve a better clinical effect,and is worthy of promotion and application.