Perioperative outcomes of mitral valvuloplasty via totally thoracoscopic approach versus traditional median sternotomy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YAN Qian ^1,2 , ZHOU Kan ² , KE Yingjie ^1,3 , YANG Liang ^1,2 , LAI Zihao ⁴ , YANG Yanchen ^1,2 , GUO Huiming ² , LU Cong ² ,  HUANG Huanlei ²

1. The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, P.R.China;
2. Department of Cardiovascular Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Cardiovascular Institute, Guangzhou, 510080, P.R.China;
3. Department of Cardiovascular Surgery, Guangdong Provincial People's Hospital's Nanhai Hospital, The Second People's Hospital of Nanhai District, Foshan, 528000, Guangdong, P.R.China;
4. The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, P.R.China;

Corresponding author：

HUANG Huanlei, Email: hhuanlei@hotmail.com

Keywords：

Totally thoracoscopic minimally invasive approach; median sternotomy; mitral valvuloplasty; perioperative outcomes

DOI：

10.7507/1007-4848.202001075

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Objective To compare the efficacy and safety of mitral valvuloplasty via minimally invasive approach with those of mitral valvuloplasty via traditional median sternotomy.Methods A total of 1 221 patients undergoing mitral valvuloplasty from January 2015 to August 2018 in Guangdong Provincial People's Hospital were analyzed retrospectively, including 721 males and 500 females, with an average age of 47.2±15.1 years. According to the different surgical methods, they were divided into a study group (n=654), who received mitral valvuloplasty via the totally thoracoscopic approach, and a control group (n=567), who received mitral valvuloplasty via traditional median sternotomy. Clinical data, surgical results, and perioperative outcomes of the two groups were compared.Results There was no significant difference in preoperative general data between the two groups (P>0.05). Compared with the control group, the study group had longer cardiopulmonary bypass time and aortic cross-clamping time (146.7±42.4 min vs. 122.7±30.6 min, 96.2±32.7 min vs. 78.3±23.8 min, both P=0.000), and shorter total operation time (227.4±55.3 min vs. 238.1±56.4 min, P=0.001). There was no significant difference in the incidence of secondary cross-clamping and mitral valve replacement between the two groups (3.7% vs. 2.6%, P=0.312; 1.7% vs. 1.4%, P=0.690). The blood transfusion rate and the incidence of respiratory tract infection and postoperative poor wound healing were lower (13.0% vs. 24.5%, 2.1% vs. 18.0%, 1.5% vs. 5.3%, all P=0.000) and the postoperative hospital stay was shorter (6.2±4.4 d vs. 11.5±8.8 d, P=0.000) in the study group. There was no significant difference in hospitalization expense between the two groups (95 847.9±31 322.0 yuan vs. 99 673.1±47 930.3 yuan, P=0.149). Within 30 d after surgery, 1 patient died in the study group and 4 patients died in the control group. Before discharge, there were 4 and 5 patients with severe mitral valve regurgitation in the study group and the control group, respectively.Conclusion Compared with mitral valvuloplasty via traditional median sternotomy, minimally invasive mitral valvuloplasty is superior in shortening operation time and postoperative hospital stay, lowering blood transfusion rate, and reducing postoperative complications, which can achieve better clinical outcomes.

Citation： YAN Qian, ZHOU Kan, KE Yingjie, YANG Liang, LAI Zihao, YANG Yanchen, GUO Huiming, LU Cong, HUANG Huanlei. Perioperative outcomes of mitral valvuloplasty via totally thoracoscopic approach versus traditional median sternotomy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(12): 1407-1412. doi: 10.7507/1007-4848.202001075 Copy

1.	Jiang Q, Yu T, Huang K, et al. Feasibility, safety, and short-term outcome of totally thoracoscopic mitral valve procedure. J Cardiothorac Surg, 2018, 13(1): 133.
2.	Holzhey DM, Seeburger J, Misfeld M, et al. Learning minimally invasive mitral valve surgery: a cumulative sum sequential probability analysis of 3895 operations from a single high-volume center. Circulation, 2013, 128(5): 483-491.
3.	赵琳, 李华, 孟欣, 等. 经食道超声心动图指导下全胸腔镜二尖瓣成形手术的新理念. 中国体外循环杂志, 2019, 17(2): 84-86.
4.	易定华, 俞世强, 徐学增, 等. 我国胸腔镜微创心脏手术技术操作规范专家共识(征求意见稿第二版). 中国胸心血管外科临床杂志, 2016, 23(4): 315-318.
5.	Coutinho GF, Antunes MJ. Mitral valve repair for degenerative mitral valve disease: surgical approach, patient selection and long-term outcomes. Heart, 2017, 103(21): 1663-1669.
6.	Tomšič A, Hiemstra YL, van Brakel TJ, et al. Outcomes of valve repair for degenerative disease in patients with mitral annular calcification. Ann Thorac Surg, 2019, 107(4): 1195-1201.
7.	Lazam S, Vanoverschelde JL, Tribouilloy C, et al. Twenty-year outcome after mitral repair versus replacement for severe degenerative mitral regurgitation: Analysis of a large, prospective, multicenter, international registry. Circulation, 2017, 135(5): 410-422.
8.	Pitsis A, Kelpis T, Theofilogiannakos E, et al. Mitral valve repair: moving towards a personalized ring. J Cardiothorac Surg, 2019, 14(1): 108.
9.	Maruszewski M, Smoczyński R, Kowalewski M, et al. Pilot study of totally thoracoscopic periareolar approach for minimally invasive mitral valve surgery. Towards even less invasive? Wideochir Inne Tech Maloinwazyjne, 2019, 14(2): 326-332.
10.	Ritwick B, Chaudhuri K, Crouch G, et al. Minimally invasive mitral valve procedures: the current state. Minim Invasive Surg, 2013, 2013: 679276.
11.	贺清, 金屏. 完全胸腔镜技术在中国心脏外科领域的发展现状. 中国胸心血管外科临床杂志, 2017, 24(1): 65-68.
12.	Paparella D, Fattouch K, Moscarelli M, et al. Current trends in mitral valve surgery: A multicenter national comparison between full-sternotomy and minimally-invasive approach. Int J Cardiol, 2020, 306: 147-151.
13.	Downs EA, Johnston LE, LaPar DJ, et al. Minimally invasive mitral valve surgery provides excellent outcomes without increased cost: a multi-institutional analysis. Ann Thorac Surg, 2016, 102(1): 14-21.
14.	García Fuster R, Martín E, Paredes F, et al. Artificial chordae in the setting of complex mitral valve repair: early outcomes using the folding leaflet technique. Interact Cardiovasc Thorac Surg, 2014, 18(5): 586-595.
15.	Panos A, Vlad S, Milas F, et al. Is minimally invasive mitral valve repair with artificial chords reproducible and applicable in routine surgery? Interact Cardiovasc Thorac Surg, 2015, 20(6): 707-711.
16.	Ito T. Techniques in mitral valve repair via a minimally invasive approach. Nihon Geka Gakkai Zasshi, 2016, 117(2): 120-123.
17.	Glauber M, Ferrarini M, Miceli A. Minimally invasive mitral valve repair using a semi-rigid annuloplasty ring with a new chordal sizing system: the Memo3D ReChord. Ann Cardiothorac Surg, 2015, 4(3): 298-300.
18.	Pojar M, Vojacek J, Karalko M, et al. Single-center experience with minimally invasive mitral operations through right minithoracotomy. Ann Thorac Cardiovasc Surg, 2019, 25(1): 18-25.
19.	Glauber M, Miceli A, Canarutto D, et al. Early and long-term outcomes of minimally invasive mitral valve surgery through right minithoracotomy: a 10-year experience in 1604 patients. J Cardiothorac Surg, 2015, 10: 181.
20.	Seeburger J, Borger MA, Doll N, et al. Comparison of outcomes of minimally invasive mitral valve surgery for posterior, anterior and bileaflet prolapse. Eur J Cardiothorac Surg, 2009, 36(3): 532-538.
21.	简杰, 卢聪, 郭惠明, 等. 二尖瓣脱垂患者微创胸腔镜二尖瓣成形术 332 例. 岭南心血管病杂志, 2017, 23(3): 298-303.
22.	朱任, 黄焕雷, 刘健, 等. 全胸腔镜人工腱索二尖瓣成形术的近期结果. 中国胸心血管外科临床杂志, 2017, 24(10): 787-790.

1. Jiang Q, Yu T, Huang K, et al. Feasibility, safety, and short-term outcome of totally thoracoscopic mitral valve procedure. J Cardiothorac Surg, 2018, 13(1): 133.
2. Holzhey DM, Seeburger J, Misfeld M, et al. Learning minimally invasive mitral valve surgery: a cumulative sum sequential probability analysis of 3895 operations from a single high-volume center. Circulation, 2013, 128(5): 483-491.
3. 赵琳, 李华, 孟欣, 等. 经食道超声心动图指导下全胸腔镜二尖瓣成形手术的新理念. 中国体外循环杂志, 2019, 17(2): 84-86.
4. 易定华, 俞世强, 徐学增, 等. 我国胸腔镜微创心脏手术技术操作规范专家共识(征求意见稿第二版). 中国胸心血管外科临床杂志, 2016, 23(4): 315-318.
5. Coutinho GF, Antunes MJ. Mitral valve repair for degenerative mitral valve disease: surgical approach, patient selection and long-term outcomes. Heart, 2017, 103(21): 1663-1669.
6. Tomšič A, Hiemstra YL, van Brakel TJ, et al. Outcomes of valve repair for degenerative disease in patients with mitral annular calcification. Ann Thorac Surg, 2019, 107(4): 1195-1201.
7. Lazam S, Vanoverschelde JL, Tribouilloy C, et al. Twenty-year outcome after mitral repair versus replacement for severe degenerative mitral regurgitation: Analysis of a large, prospective, multicenter, international registry. Circulation, 2017, 135(5): 410-422.
8. Pitsis A, Kelpis T, Theofilogiannakos E, et al. Mitral valve repair: moving towards a personalized ring. J Cardiothorac Surg, 2019, 14(1): 108.
9. Maruszewski M, Smoczyński R, Kowalewski M, et al. Pilot study of totally thoracoscopic periareolar approach for minimally invasive mitral valve surgery. Towards even less invasive? Wideochir Inne Tech Maloinwazyjne, 2019, 14(2): 326-332.
10. Ritwick B, Chaudhuri K, Crouch G, et al. Minimally invasive mitral valve procedures: the current state. Minim Invasive Surg, 2013, 2013: 679276.
11. 贺清, 金屏. 完全胸腔镜技术在中国心脏外科领域的发展现状. 中国胸心血管外科临床杂志, 2017, 24(1): 65-68.
12. Paparella D, Fattouch K, Moscarelli M, et al. Current trends in mitral valve surgery: A multicenter national comparison between full-sternotomy and minimally-invasive approach. Int J Cardiol, 2020, 306: 147-151.
13. Downs EA, Johnston LE, LaPar DJ, et al. Minimally invasive mitral valve surgery provides excellent outcomes without increased cost: a multi-institutional analysis. Ann Thorac Surg, 2016, 102(1): 14-21.
14. García Fuster R, Martín E, Paredes F, et al. Artificial chordae in the setting of complex mitral valve repair: early outcomes using the folding leaflet technique. Interact Cardiovasc Thorac Surg, 2014, 18(5): 586-595.
15. Panos A, Vlad S, Milas F, et al. Is minimally invasive mitral valve repair with artificial chords reproducible and applicable in routine surgery? Interact Cardiovasc Thorac Surg, 2015, 20(6): 707-711.
16. Ito T. Techniques in mitral valve repair via a minimally invasive approach. Nihon Geka Gakkai Zasshi, 2016, 117(2): 120-123.
17. Glauber M, Ferrarini M, Miceli A. Minimally invasive mitral valve repair using a semi-rigid annuloplasty ring with a new chordal sizing system: the Memo3D ReChord. Ann Cardiothorac Surg, 2015, 4(3): 298-300.
18. Pojar M, Vojacek J, Karalko M, et al. Single-center experience with minimally invasive mitral operations through right minithoracotomy. Ann Thorac Cardiovasc Surg, 2019, 25(1): 18-25.
19. Glauber M, Miceli A, Canarutto D, et al. Early and long-term outcomes of minimally invasive mitral valve surgery through right minithoracotomy: a 10-year experience in 1604 patients. J Cardiothorac Surg, 2015, 10: 181.
20. Seeburger J, Borger MA, Doll N, et al. Comparison of outcomes of minimally invasive mitral valve surgery for posterior, anterior and bileaflet prolapse. Eur J Cardiothorac Surg, 2009, 36(3): 532-538.
21. 简杰, 卢聪, 郭惠明, 等. 二尖瓣脱垂患者微创胸腔镜二尖瓣成形术 332 例. 岭南心血管病杂志, 2017, 23(3): 298-303.
22. 朱任, 黄焕雷, 刘健, 等. 全胸腔镜人工腱索二尖瓣成形术的近期结果. 中国胸心血管外科临床杂志, 2017, 24(10): 787-790.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Perioperative outcomes of mitral valvuloplasty via totally thoracoscopic approach versus traditional median sternotomy

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