ObjectiveTo compare early outcomes of the minimally invasive mitral valve surgery (MIMVS) through right anterolateral mini-thoracotomy (ALMT) with conventional mitral valve surgery (MVS), and evaluate feasibility and safety of MIMVS. MethodsFrom January 2011 to December 2013, 120 patients undergoing elective MVS in Nanjing First Hospital were prospectively enrolled in this study. There were 72 male and 48 female patients with their age of 22-71 (42.4±11.0) years. Using a random number table, all the patients were randomly divided into a portaccess MIMVS group (MIMVS group, n=60) and a conventional MVS group (conventional group, n=60). MIMVS group patients received port-access cardiopulmonary bypass (CPB) establishment via femoral artery, femoral vein and right internal jugular vein cannulation through right ALMT 5-6 cm in length. Special MIMVS operative instruments were used for mitral valve repair or replacement. Conventional group patients received mitral valve repair or replacement under conventional CPB through median sternotomy. Perioperative clinical data, morbidity and mortality were compared between the 2 groups. ResultsThere was no death in-hospital or shortly after discharge in this study. CPB time (98.0±26.0 minutes vs. 63.0±21.0 minutes) and aortic cross-clamping time (68.0±9.0 minutes vs.37.0±6.0 minutes) of MIMVS group were significantly longer than those of conventional group (P<0.05). Postoperative mechanical ventilation time (6.0±3.9 hours vs. 11.2±5.6 hours), length of ICU stay (18.5±3.0 hours vs. 28.6±9.5 hours) and postoperative hospital stay (8.0±2.0 days vs. 13.5±2.5 days) of MIMVS group were significantly shorter than those of conventional group (P<0.05). Chest drainage volume within postoperative 12 hours (110.0±30.0 ml vs. 385.0±95.0 ml) and the percentage of patients receiving blood transfusion (25.0% vs. 58.3%) of MIMVS group were significantly lower than those of conventional group (P<0.05). Patients were followed up for 1-24 months, and the follow-up rate was 94.2%. There was no statistical difference in postoperative morbidity or mortality between the 2 groups (P>0.05). ConclusionMIMVS through right ALMT is a safe and feasible procedure for surgical treatment of mitral valve diseases. MIMVS can achieve similar clinical outcomes as conventional MVS, but can significantly shorten postoperative ICU stay and hospital stay, reduce blood transfusion, and is a good alternative to conventional MVS.
ObjectiveTo summarize the clinical experience in the treatment of Carpentier's type Ⅲb ischemic mitral regurgitation through the mitral valve repair versus mitral valve replacement, and to evaluate the early and midlong term effects. MethodsWe retrospectively analyzed the clinical data of 308 consecutive patients with type Ⅲb ischemic mitral regurgitation undergoing coronary artery bypass grafting (CABG) with mitral valve repair (a repair group, n=172) or with mitral valve replacement (a replacement group, n=136) in our hospital between January 2000 and March 2014. Among the 308 patients, 215 were males and 93 were females with mean age of 62.7±11.5 years(ranged 30-78 years). In the repair group, 170 patients underwent restrictive mitral annuloplasty (128 patients with total ring, 42 patients with C ring), and 2 patients underwent commissural constriction. In the replacement group, 11 patients underwent mechanical valve prosthesis and 125 patients underwent biological valve prosthesis. ResultsThe time of total aortic cross-clamp was 81.9±21.5 min. The time of total extracorporeal circulation was 122.0±31.3 min. Six patients died during the perioperative period. No significant differences were observed between the two groups in general information (P>0.05). There were no significant differences between the two groups in aortic cross-clamp time, total extracorporeal circulation time, numbers of bypass grafts and the usage rate of left internal mammary artery. The early result after the surgery showed that the incidence rates of low cardiac output and ventricular arrhythmia were significantly higher in the replacement group compared with those in the repair group. The patients were followed up for 1-85 months. No significant difference was revealed in the mid-long term survival rate between the two groups. The severity of mitral regurgitation and the rate of redo mitral valve replacement were significantly lower in the replacement group compared with those in the repair group (P<0.05). ConclusionThe early-term curative effect of valve repair is better than valve replacement for the treatment of Carpentier's type Ⅲb ischemic mitral regurgitation. In mid-long term, Chordal-sparing mitral valve replacement remains a low incidence of valve-related complications compared with mitral valve repair.