Eearly outcomes of totally thoracoscopic minimally invasive aortic valve and double valve replacement_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Zhenzhong ¹ , YANG Yanchen ¹ ,  HUANG Huanlei ^1,2 , ZHONG Lishan ² , TIAN Chengnan ³ , CHEN Zerui ² , HE Biaochuan ² , ZANG Xin ² , ZHAO Junfei ² , GUO Huiming ²

1. South China University of Technology School of Medicine, Guangzhou, 510006, P. R. China;
2. Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, P. R. China;
3. The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, P. R. China;

Corresponding author：

HUANG Huanlei, Email: hhuanlei@hotmail.com

Keywords：

Total thoracoscopy; minimally invasive cardiac surgery; aortic valve replacement; double valve replacement

DOI：

10.7507/1007-4848.202104018

Video：

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Objective To summarize the early outcomes of totally thoracoscopic minimally invasive aortic valve replacement (AVR) and double valve replacement (DVR).Methods The clinical data of patients who underwent totally thoracoscopic minimally invasive AVR or DVR in Guangdong Provincial People’s Hospital from April 2020 to January 2021 were retrospectively analyzed. The patients were divided into an AVR group and a DVR group according to the surgical method, and the clinical data of the two groups were compared.Results Finally 22 patients were enrolled, including 14 males and 8 females with an average age of 50.0±11.2 years at operation. Eight patients were degenerative disease, 8 were rheumatic heart disease combined with valvular disease, and 6 were bicuspid aortic valve. Out of the 22 patients, 16 underwent AVR alone, and 6 underwent DVR. All patients completed the operation successfully, and there was no death. Perivalvular leakage during surgery occurred in 2 patients. The average cardiopulmonary bypass time was 187.0±39.9 minutes, and aortic cross-clamping time was 117.0 (99.0, 158.0) minutes. Duration of mechanical ventilation and intensive care unit stay was 9.5 (4.8, 18.3) hours and 41.0 (34.0, 64.0) hours, respectively. The volume of chest drainage at the first 24 hours after surgery was 214.0±124.6 mL, and the postoperative hospital stay was 5.5 (4.0, 8.3) days. The cardiopulmonary bypass time and aortic cross-clamping time in the DVR group were longer than those in the AVR group, and the volume of chest drainage at 24 hours after surgery was more than that in the AVR group, with a statistical difference (P＜0.05). Echocardiography before hospital discharge showed paravalvular leakage in 1 patient. There was no death during follow-up of 5.9±3.0 months. Conclusion The early outcome of totally thoracoscopic minimally invasive AVR and DVR is satisfactory, and the approach of surgery is worth exploring.

Citation： WANG Zhenzhong, YANG Yanchen, HUANG Huanlei, ZHONG Lishan, TIAN Chengnan, CHEN Zerui, HE Biaochuan, ZANG Xin, ZHAO Junfei, GUO Huiming. Eearly outcomes of totally thoracoscopic minimally invasive aortic valve and double valve replacement. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(5): 710-717. doi: 10.7507/1007-4848.202104018 Copy

1.	Reser D, van Hemelrijck M, Pavicevic J, et al. Repair rate and durability of video assisted minimally invasive mitral valve surgery. J Card Surg, 2014, 29(6): 766-771.
2.	王炜, 王玮璠, 王石雄, 等. 全胸腔镜下二尖瓣手术97例经验总结. 临床心血管病杂志, 2019, 35(4): 306-309.
3.	柯英杰, 陈泽锐, 黄焕雷, 等. 微创三尖瓣补片扩大成形用于再次心脏手术. 中国胸心血管外科临床杂志, 2018, 25(7): 577-582.
4.	Casselman FP, La Meir M, Jeanmart H, et al. Endoscopic mitral and tricuspid valve surgery after previous cardiac surgery. Circulation, 2007, 116(11 Suppl): I270-I275.
5.	Ueno G, Ohno N. Aortic valve approaches in the era of minimally invasive cardiac surgery. Surg Today, 2020, 50(8): 815-820.
6.	Vola M, Fuzellier JF, Chavent B, et al. First human totally endoscopic aortic valve replacement: An early report. J Thorac Cardiovasc Surg, 2014, 147(3): 1091-1093.
7.	Vola M, Fuzellier JF, Campisi S, et al. Closed chest human aortic valve removal and replacement: Technical feasibility and one year follow-up. Int J Cardiol, 2016, 211: 71-78.
8.	Balkhy HH, Kitahara H. First human totally endoscopic robotic-assisted sutureless aortic valve replacement. Ann Thorac Surg, 2020, 109(1): e9-e11.
9.	Qiao Y, An G, Chen G, et al. Minimally invasive video-assisted double-valve replacement through right anterolateral minithoracotomy. Heart Lung Circ, 2014, 23(9): 847-851.
10.	Kypson AP, Glower DD. Minimally invasive tricuspid operation using port access. Ann Thorac Surg, 2002, 74(1): 43-45.
11.	Carpentier A, Loulmet D, Carpentier A, et al. Open heart operation under videosurgery and minithoracotomy. First case (mitral valvuloplasty) operated with success. C R Acad Sci Ⅲ, 1996, 319(3): 219-223.
12.	程云阁, 肖明第, 贾宝成, 等. 完全胸腔镜下二尖瓣手术272例. 中华胸心血管外科杂志, 2012, 28(4): 198-199, 211.
13.	颜倩, 周勘, 柯英杰, 等. 全腔镜微创与传统正中开胸二尖瓣成形的围术期临床结果比较. 中国胸心血管外科临床杂志, 2020, 27(12): 1407-1412.
14.	Gumus F, Hasde AI, Bermede O, et al. Multiple valve implantation through a minimally invasive approach: Comparison of standard median sternotomy and right anterior thoracotomy. Heart Lung Circ, 2020, 29(9): 1418-1423.
15.	龙艳丽, 周榕, 祁明, 等. 胸腔镜辅助微创二尖瓣及主动脉瓣双瓣置换术14例临床分析. 心肺血管病杂志, 2016, 35(1): 38-40, 67.
16.	Tokoro M, Sawaki S, Ozeki T, et al. Totally endoscopic aortic valve replacement via an anterolateral approach using a standard prosthesis. Interact Cardiovasc Thorac Surg, 2020, 30(3): 424-430.
17.	Cresce GD, Sella M, Hinna Danesi T, et al. Minimally invasive endoscopic aortic valve replacement: Operative results. Semin Thorac Cardiovasc Surg, 2020, 32(3): 416-423.
18.	Van Praet KM, van Kampen A, Kofler M, et al. Minimally invasive surgical aortic valve replacement: The RALT approach. J Card Surg, 2020, 35(9): 2341-2346.
19.	Cosgrove DM, Sabik JF. Minimally invasive approach for aortic valve operations. Ann Thorac Surg, 1996, 62(2): 596-597.
20.	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.
21.	Grossi EA, Galloway AC, Ribakove GH, et al. Impact of minimally invasive valvular heart surgery: A case-control study. Ann Thorac Surg, 2001, 71(3): 807-810.

1. Reser D, van Hemelrijck M, Pavicevic J, et al. Repair rate and durability of video assisted minimally invasive mitral valve surgery. J Card Surg, 2014, 29(6): 766-771.
2. 王炜, 王玮璠, 王石雄, 等. 全胸腔镜下二尖瓣手术97例经验总结. 临床心血管病杂志, 2019, 35(4): 306-309.
3. 柯英杰, 陈泽锐, 黄焕雷, 等. 微创三尖瓣补片扩大成形用于再次心脏手术. 中国胸心血管外科临床杂志, 2018, 25(7): 577-582.
4. Casselman FP, La Meir M, Jeanmart H, et al. Endoscopic mitral and tricuspid valve surgery after previous cardiac surgery. Circulation, 2007, 116(11 Suppl): I270-I275.
5. Ueno G, Ohno N. Aortic valve approaches in the era of minimally invasive cardiac surgery. Surg Today, 2020, 50(8): 815-820.
6. Vola M, Fuzellier JF, Chavent B, et al. First human totally endoscopic aortic valve replacement: An early report. J Thorac Cardiovasc Surg, 2014, 147(3): 1091-1093.
7. Vola M, Fuzellier JF, Campisi S, et al. Closed chest human aortic valve removal and replacement: Technical feasibility and one year follow-up. Int J Cardiol, 2016, 211: 71-78.
8. Balkhy HH, Kitahara H. First human totally endoscopic robotic-assisted sutureless aortic valve replacement. Ann Thorac Surg, 2020, 109(1): e9-e11.
9. Qiao Y, An G, Chen G, et al. Minimally invasive video-assisted double-valve replacement through right anterolateral minithoracotomy. Heart Lung Circ, 2014, 23(9): 847-851.
10. Kypson AP, Glower DD. Minimally invasive tricuspid operation using port access. Ann Thorac Surg, 2002, 74(1): 43-45.
11. Carpentier A, Loulmet D, Carpentier A, et al. Open heart operation under videosurgery and minithoracotomy. First case (mitral valvuloplasty) operated with success. C R Acad Sci Ⅲ, 1996, 319(3): 219-223.
12. 程云阁, 肖明第, 贾宝成, 等. 完全胸腔镜下二尖瓣手术272例. 中华胸心血管外科杂志, 2012, 28(4): 198-199, 211.
13. 颜倩, 周勘, 柯英杰, 等. 全腔镜微创与传统正中开胸二尖瓣成形的围术期临床结果比较. 中国胸心血管外科临床杂志, 2020, 27(12): 1407-1412.
14. Gumus F, Hasde AI, Bermede O, et al. Multiple valve implantation through a minimally invasive approach: Comparison of standard median sternotomy and right anterior thoracotomy. Heart Lung Circ, 2020, 29(9): 1418-1423.
15. 龙艳丽, 周榕, 祁明, 等. 胸腔镜辅助微创二尖瓣及主动脉瓣双瓣置换术14例临床分析. 心肺血管病杂志, 2016, 35(1): 38-40, 67.
16. Tokoro M, Sawaki S, Ozeki T, et al. Totally endoscopic aortic valve replacement via an anterolateral approach using a standard prosthesis. Interact Cardiovasc Thorac Surg, 2020, 30(3): 424-430.
17. Cresce GD, Sella M, Hinna Danesi T, et al. Minimally invasive endoscopic aortic valve replacement: Operative results. Semin Thorac Cardiovasc Surg, 2020, 32(3): 416-423.
18. Van Praet KM, van Kampen A, Kofler M, et al. Minimally invasive surgical aortic valve replacement: The RALT approach. J Card Surg, 2020, 35(9): 2341-2346.
19. Cosgrove DM, Sabik JF. Minimally invasive approach for aortic valve operations. Ann Thorac Surg, 1996, 62(2): 596-597.
20. 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.
21. Grossi EA, Galloway AC, Ribakove GH, et al. Impact of minimally invasive valvular heart surgery: A case-control study. Ann Thorac Surg, 2001, 71(3): 807-810.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Eearly outcomes of totally thoracoscopic minimally invasive aortic valve and double valve replacement

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