Clinical Study Of Minimally Invasive Aortic Valve Replacement Through Right Parasternal Second Intercostal Transverse Incision

Objective:To explore the safety and feasibility of minimally invasive aortic valve replacement through second paracostal incision in the right parasternal.Methods:A retrospective analysis of the clinical data of 111 patients undergone simple aortic valve replacement performed by the same surgeon in the Second Affiliated Hospital of Nanchang University from January 2018 to December 2019.According to the surgical method,they were divided into two groups.One group includes 49 cases of minimally invasive aortic valve replacement in the right parasternal second intercostal transverse incision(minimally invasive group),another includes 62 cases of median sternotomy aortic valve replacement(median group).Statistical analysis was performed on SPSS21.0 software.The independent-sample t-test analysis was used to compare characteristics,preoperative left ventricular ejection fraction,preoperative left ventricular end-diastolic diameter,operation time,CPB time,cross-clamp time,CSICU stay,assisted ventilation time,postoperative drainage of the first 24 h,postoperative hospital stay,postoperative left ventricular ejection fraction,postoperative left ventricular end-diastolic diameter of the two groups.Chi-square test analysis was performed to compare the rate of blood transfusion,the rate of secondary thoracotomy,the incidence of postoperative related complications,and mortality.P <0.05 indicates that the difference is statistically significant.Results:The surgery was successful in both groups.There was no transition to thoracotomy in the minimally invasive group,and no patients died during and after surgery.All patients recovered and were discharged from the hospital.There was no significant difference in the characteristics between the minimally invasive group and the median group(P> 0.05).Preoperative left ventricular ejection fractions in thetwo groups were 61.16 ± 9.07% and 61.86 ± 8.45%(P = 0.679),and preoperative left ventricular end-diastolic diameters were 56.78 ± 10.51 mm and 55.71 ± 8.60mm(P = 0.558),and the differences were no statistically significant(P> 0.05).The CBP time of the two groups were 95.80 ± 16.22 min and 87.03 ± 23.80 min(P = 0.023),and cross-clamp time were 66.78 ± 15.91 min and 58.97 ± 15.62 min(P = 0.011),and the differences were statistically significant(P <0.05).The operation time in the two groups were 233.47 ± 30.95 min and 236.79 ± 39.01min(P = 0.618),and there were no significant difference(P> 0.05).The postoperative ventilator assistance time of the two groups were 15.45 ± 5.75 h and 18.51 ± 6.71h(P = 0.012),CSICU stay time were 1.77 ± 0.31 d and 2.04 ± 0.63d(P = 0.004),postoperative hospital stays were 8.69 ± 2.75 d and 10.77 ± 2.94d(P <0.001),and postoperative drainage of the first 24 h were 109.86 ± 125.98 ml and 508.84 ± 311.70ml(P <0.001),and the rate of blood transfusion during the first 24 h were 22.4% and 46.8%(P = 0.008),the differences were statistically significant(P <0.05).The postoperative left ventricular ejection fractions in the two groups were 56.63 ± 8.03% and 58.71 ± 7.89%(P =0.174),and the postoperative left ventricular end-diastolic diameter were 44.45 ±6.45 mm and 45.08 ± 5.81mm(P = 0.589),the differences were no statistically significant(P> 0.05).In the minimally invasive group,1 case had reoperation for bleeding,2 had a pneumothorax,2 had pleural effusion,and 5 had atrial fibrillation.In the median group,1 case had reoperation for bleeding,3 had pleural effusion,5had atrial fibrillation,1 had renal insufficiency,and 2 had poor wound healing.The postoperative atrial fibrillation rates in the minimally invasive group and the median groups were 10.2% and 30.6%(P = 0.009)respectively,and the difference was statistically significant(P <0.05).There were no significant differences in the incidence of other postoperative complications and mortality between the two groups(P> 0.05).Conclusion:The effect of minimally invasive aortic valve replacement through the right parasternal second intercostal transverse incision is equivalent to that of the sternotomy aortic valve replacement and does not increase the probability ofcomplications.Besides,the operation has less trauma,quick recovery,safety,and feasibility,and is worthy of clinical application.