Comparison Of Mitral Valvuloplasty Through Totally Thoracoscopic And Right Anterolateral Mini-thoracotomy

Objective: To compare the safety and efficacy of mitral valvuloplasty(MVP)through total thoracoscopy and right anterolateral mini-thoracotomy.To explore the advantages and application values of the two minimally invasive surgical approaches,and to summarize the surgical experience.Methods: From January 2013 to June 2019,patients with mitral regurgitation(MR)who underwent MVP surgery in our hospital were collected and screened strictly according to the inclusion and exclusion criteria.The 84 patients enrolled,aged(47.56±11.97)years,were divided into three groups by different surgical approaches: totally thoracoscopic group(27 cases),right anterolateral mini-thoracotomy group(11 cases),and median thoracotomy control group(46 cases).The total thoracoscopy group and the mini-thoracotomy group establish extracorporeal circulation through femoral arterial and venous intubation.The perioperative data of the three groups of patients were collected for comparison.Results: The surgery was successfully completed in all three groups.Compared with the median thoracotomy group,longer aortic cross clamp time and cardiopulmonary bypass time were found in the totally thoracoscopic and right anterolateral mini-thoracotomy group with P value greater than 0.05.The aortic cross clamp time and cardiopulmonary bypass time was slightly prolonged in totally thoracoscopic group compare with right anterolateral mini-thoracotomy group,but the difference was not statistically significant(P> 0.05).The thoracoscopy group and the mini-thoracotomy group were better than the median thoracotomy group in terms of 24 h postoperative drainage,blood product infusion,ICU observation time,mechanically assisted ventilation time,and postoperative hospital stay days,and the differences were statistically significant(P <0.05).And the above indexes were not significantly different between the thoracoscopy group and the mini-thoracotomy group(P> 0.05).Within 72 hours after surgery,the cumulative dose of morphine in the mini-thoracotomy group was equivalent to that of the median thoracotomy group(P> 0.05),and both were larger than the total thoracoscopy group,and the difference was statistically significant(P <0.05).In addition,there were no statistical differences in hospital costs,postoperative complications,and postoperative follow-up results at 6 months(P> 0.05).Conclusions: Compared with the standard approach of median thoracotomy,MVP surgery through total thoracoscopy and right anterolateral mini-thoracotomy is safe and effective.Compared with the right anterolateral mini-thoracotomy the incision of total thoracoscopic surgery was small,and the injury of intercostal nerve was light.However,the surgical approach of totally thoracoscopic surgery was narrow,which increased the difficulty and time of operation slightly.Both the minimally invasive approaches have clinical value,which can be selected to use according to the patient's wishes,the skill and experience of the surgeon.