The therapeutic effect and mid-term follow-up of 154 patients of multiple valvular surgery through right anterolateral intercostal thoracotomy: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIANG Hongliang , CHEN Tao , DUAN Weixun , YI Wei , CHENG Liang , DONG Xiaochao , LIU Yang , ZHAO Diancai , JI Pengfei ,  LIU Jincheng

Department of Cardiovascular Surgery, The First Affiliated Hospital of Air Force Medical University, Xi’an, 710032, P.R.China;

Corresponding author：

LIU Jincheng, Email: liujch69@sina.com

Keywords：

Multiple valvular disease; minimally invasive surgery; anterolateral thoracotomy

DOI：

10.7507/1007-4848.202011033

Video：

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Objective To investigate the therapeutic effect, safety and effectiveness of multiple valvular surgery through right anterolateral intercostal thoracotomy, as well as the mid-term follow-up results and surgeon's learning curve.Methods The clinical data of 154 patients with multiple valvular disease were performed minimally invasive cardiac surgery in the Department of Cardiovascular Surgery, The First Affiliated Hospital of Air Force Medical University, from 2015 to 2019 were retrospectively analyzed. There were 103 males and 51 females, aged 23-68 years. Closed cardiopulmonary bypass was established through femoral artery and femoral vein, and the thoracic cavity was entered through a 6 cm transverse incision in the fourth intercostal space on the right side of sternum. Baseline and perioperative characteristics and postoperative outcomes were reviewed.Results There was no perioperative death. The average cardiopulmonary bypass time was 159.3±39.4 min, and the aortic clamping time was 102.3±20.3 min. One patient underwent thoracotomy during the operation, and two patients underwent second thoracotomy for hemostasis. During the follow-up period of 10-55 months, 1 patient died, 2 patients developed mild perivalvular regurgitation, 6 patients developed moderate tricuspid regurgitation, and no serious cardiovascular events occurred in the rest of the patients.Conclusion Our findings demonstrate that multiple valvular surgery through right anterolateral intercostal thoracotomy is safe, and in an acceptable risk of complication. The early and middle follow-up results are satisfactory. The minimally invasive cardiac surgery can also meet the requirements of cosmetology, and is conducive to the recovery of patients' mental and physical health. This method is worthy of application in medical centers with rich experience in routine cardiac surgery.

Citation： LIANG Hongliang, CHEN Tao, DUAN Weixun, YI Wei, CHENG Liang, DONG Xiaochao, LIU Yang, ZHAO Diancai, JI Pengfei, LIU Jincheng. The therapeutic effect and mid-term follow-up of 154 patients of multiple valvular surgery through right anterolateral intercostal thoracotomy: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(2): 164-168. doi: 10.7507/1007-4848.202011033 Copy

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2.	Cohn LH, Adams DH, Couper GS, et al. Minimally invasive cardiac valve surgery improves patient satisfaction while reducing costs of cardiac valve replacement and repair. Ann Surg, 1997, 226(4): 421-426.
3.	Murzi M, Cerillo AG, Bevilacqua S, et al. Traversing the learning curve in minimally invasive heart valve surgery: a cumulative analysis of an individual surgeon's experience with a right minithoracotomy approach for aortic valve replacement. Eur J Cardiothorac Surg, 2012, 41(6): 1242-1246.
4.	Qiu Z, Chen X, Xu Y, et al. Does full sternotomy have more significant impact than the cardiopulmonary bypass time in patients of mitral valve surgery? J Cardiothorac Surg, 2018, 13(1): 29.
5.	Schmitto JD, Mokashi SA, Cohn LH. Minimally-invasive valve surgery. J Am Coll Cardiol, 2010, 56(6): 455-462.
6.	Risteski P, Monsefi N, Miskovic A, et al. Triple valve surgery through a less invasive approach: early and mid-term results. Interact Cardiovasc Thorac Surg, 2017, 24(5): 677-682.
7.	Elmahdy HM, Nascimento FO, Santana O, et al. Outcomes of minimally invasive triple valve surgery performed via a right anterior thoracotomy approach. J Heart Valve Dis, 2013, 22(5): 735-739.
8.	Leone A, Fortuna D, Gabbieri D, et al. Triple valve surgery: results from a multicenter experience. J Cardiovasc Med (Hagerstown), 2018, 19(7): 382-388.
9.	Ohmes LB, Kim L, Feldman DN, et al. Contemporary prevalence, in-hospital outcomes, and prognostic determinants of triple valve surgery: National database review involving 5, 234 patients. Int J Surg, 2017, 44: 132-138.
10.	Noack T, Emrich F, Kiefer P, et al. Preoperative predictors and outcome of triple valve surgery in 487 consecutive patients. Thorac Cardiovasc Surg, 2017, 65(3): 174-181.
11.	Liang NE, Wisneski AD, Wang SX, et al. Veterans affairs heart team experience with transcatheter aortic valve replacement and minimally invasive surgical aortic valve replacement. J Invasive Cardiol, 2019, 31(8): 217-222.
12.	Wang A, McCartney SL, Williams JB, et al. Use of adjuncts reduces cardiopulmonary bypass time during minimally invasive aortic valve replacement. J Heart Valve Dis, 2017, 26(2): 155-160.
13.	Atik FA, Svensson LG, Blackstone EH, et al. Less invasive versus conventional double-valve surgery: a propensity-matched comparison. J Thorac Cardiovasc Surg, 2011, 141(6): 1461-1468.
14.	Mihos CG, Pineda AM, Davila H, et al. Combined mitral and tricuspid valve surgery performed via a right minithoracotomy approach. Innovations (Phila), 2015, 10(5): 304-308.
15.	Santana O, Xydas S, Williams RF, et al. Outcomes of minimally invasive double valve surgery. J Thorac Dis, 2017, 9(Suppl 7): S602-S606.
16.	Musumeci F, Lio A, Montalto A, et al. Minimally invasive treatment of multiple valve disease: A modified approach through a right lateral minithoracotomy. J Card Surg, 2020, 35(1): 135-139.

1. Navia JL, Cosgrove DM. Minimally invasive mitral valve operations. Ann Thorac Surg, 1996, 62(5): 1542-1544.
2. Cohn LH, Adams DH, Couper GS, et al. Minimally invasive cardiac valve surgery improves patient satisfaction while reducing costs of cardiac valve replacement and repair. Ann Surg, 1997, 226(4): 421-426.
3. Murzi M, Cerillo AG, Bevilacqua S, et al. Traversing the learning curve in minimally invasive heart valve surgery: a cumulative analysis of an individual surgeon's experience with a right minithoracotomy approach for aortic valve replacement. Eur J Cardiothorac Surg, 2012, 41(6): 1242-1246.
4. Qiu Z, Chen X, Xu Y, et al. Does full sternotomy have more significant impact than the cardiopulmonary bypass time in patients of mitral valve surgery? J Cardiothorac Surg, 2018, 13(1): 29.
5. Schmitto JD, Mokashi SA, Cohn LH. Minimally-invasive valve surgery. J Am Coll Cardiol, 2010, 56(6): 455-462.
6. Risteski P, Monsefi N, Miskovic A, et al. Triple valve surgery through a less invasive approach: early and mid-term results. Interact Cardiovasc Thorac Surg, 2017, 24(5): 677-682.
7. Elmahdy HM, Nascimento FO, Santana O, et al. Outcomes of minimally invasive triple valve surgery performed via a right anterior thoracotomy approach. J Heart Valve Dis, 2013, 22(5): 735-739.
8. Leone A, Fortuna D, Gabbieri D, et al. Triple valve surgery: results from a multicenter experience. J Cardiovasc Med (Hagerstown), 2018, 19(7): 382-388.
9. Ohmes LB, Kim L, Feldman DN, et al. Contemporary prevalence, in-hospital outcomes, and prognostic determinants of triple valve surgery: National database review involving 5, 234 patients. Int J Surg, 2017, 44: 132-138.
10. Noack T, Emrich F, Kiefer P, et al. Preoperative predictors and outcome of triple valve surgery in 487 consecutive patients. Thorac Cardiovasc Surg, 2017, 65(3): 174-181.
11. Liang NE, Wisneski AD, Wang SX, et al. Veterans affairs heart team experience with transcatheter aortic valve replacement and minimally invasive surgical aortic valve replacement. J Invasive Cardiol, 2019, 31(8): 217-222.
12. Wang A, McCartney SL, Williams JB, et al. Use of adjuncts reduces cardiopulmonary bypass time during minimally invasive aortic valve replacement. J Heart Valve Dis, 2017, 26(2): 155-160.
13. Atik FA, Svensson LG, Blackstone EH, et al. Less invasive versus conventional double-valve surgery: a propensity-matched comparison. J Thorac Cardiovasc Surg, 2011, 141(6): 1461-1468.
14. Mihos CG, Pineda AM, Davila H, et al. Combined mitral and tricuspid valve surgery performed via a right minithoracotomy approach. Innovations (Phila), 2015, 10(5): 304-308.
15. Santana O, Xydas S, Williams RF, et al. Outcomes of minimally invasive double valve surgery. J Thorac Dis, 2017, 9(Suppl 7): S602-S606.
16. Musumeci F, Lio A, Montalto A, et al. Minimally invasive treatment of multiple valve disease: A modified approach through a right lateral minithoracotomy. J Card Surg, 2020, 35(1): 135-139.

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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

The therapeutic effect and mid-term follow-up of 154 patients of multiple valvular surgery through right anterolateral intercostal thoracotomy: A retrospective cohort study

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