Clinical Outcomes of Minimally Invasive Mitral Valvuloplasty via Right Anterolateral Minithoracotomy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIUHong-duan ¹ , LIXin ¹ ,  YUFeng-xu ¹ , DENGMing-bin ¹ , LIULi-ming ²

1. Department of Cardiothoracic Surgery, Affiliated Hospital of Luzhou Medical College, Luzhou 646000, Sichuan, P. R. China;
2. Second Xiangya Hospital of Central South University, Changsha 410011, P. R. China;

Corresponding?author：

YUFeng-xu, Email: yuluchuan@163.com

Keywords：

Minimally invasive surgery; Right anterolateral minithoracotomy; Mitral valvuloplasty; Cardiopulmonary bypass

DOI：

10.7507/1007-4848.20140057

Video：

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Objective To analyze clinical outcomes of mitral valvuloplasty (MVP) via right anterolateral minithoracotomy. Methods Clinical data of 23 patients with valvular heart disease who underwent minimally invasive MVP via right anterolateral minithoracotomy from January 2011 to February 2013 in the Department of Cardiothoracic Surgery in our hospital were retrospectively analyzed. There were 8 males and 15 females with mean age of 41±10 years. The procedure was performed through a small (4-6 cm) incision via right anterolateral minithoracotomy. Cardiopulmonary bypass (CPB) was established via femoral artery and vein cannulation. Transthoracic clamp was used for ascending aortic clamping. Cold blood cardioplegia was delivered after aortic cross-clamping. Left atrial drainage was established through right superior pulmonary vein. MVP was performed through the atrial septal approach,and tricuspid valvuloplasty was performed for tricuspid regurgitation if necessary. Results All the operations were successfully performed without in-hospital death. Operation duration was 160-290 (229±37) minutes. Aortic cross-clamping time was 40-121 (67±19) minutes. CPB duration was 60-136 (87±21) minutes. Postoperative mechanical ventilation time was 6-47 (16±11) hours. The length of intensive care unit stay was 19-60 (30±12) hours. Postoperative chest drainage was 80-780 (320±184) ml. Postoperative color Doppler echocardiography showed that left ventricular ejection fraction was 49%-65% (56.0%±4.8%). There were 5 patients with trivial mitrial valve regurgitation and 6 patients with mild tricuspid valve regurgitation. Postoperative mean length of the right thoracic incision was 3.9-6.0 (5.3±0.7) cm. The patients were followed up for 1-24 months. The result of echocardiography showed no modern to severe valve regurgitation. Conclusion Minimally invasive MVP via right anterolateral minithoracotomy is safe and feasible with satisfactory cosmetic and clinical results.

Citation： LIUHong-duan, LIXin, YUFeng-xu, DENGMing-bin, LIULi-ming. Clinical Outcomes of Minimally Invasive Mitral Valvuloplasty via Right Anterolateral Minithoracotomy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(2): 194-197. doi: 10.7507/1007-4848.20140057 Copy

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9.	Aybek T,Dogan S,Wimmer-Greinecker G,et al.The micro-mitral operation comparing the Port-Access technique and the transthoracic clamp technique.J Card Surg,2000,15 (1):76-81.
10.	魏來,王春生,沈金強,等.Chitwood法微創心臟瓣膜手術115例臨床分析.中華外科雜志,2011,49 (4):373-375.
11.	Pfannmüller B,Misfeld M,Borger MA,et al.Isolated reoperative minimally invasive tricuspid valve operations.Ann Thorac Surg,2012,94 (6):2005-2010.
12.	Murzi M,Solinas M,Bevilacqua S,et al.A new left atrial retractor for minimally invasive mitral valve surgery.J Card Surg,2009,24 (2):175-177.
13.	謝基嚴,周清華,主譯.心胸外科學精要.第2版.天津:科技翻譯出版公司,2010.363-364.
14.	鄧學峰,高長青.二尖瓣成形術治療二尖瓣關閉不全.中國胸心血管外科臨床雜志,2008,15 (2):134-137.
15.	Chen X,Turley RS,Andersen ND,et al.Minimally invasive edge-toedge mitral repair with or without artificial chordae.Ann Thorac Surg,2013,95 (4):1347-1353.
16.	Bhudia SK,McCarthy PM,Smedira NG,et al.Edge-to-edge (Alfieri) mitral repair:results in diverse clinical settings.Ann Thorac Surg,2004,77 (5):1598-1606.
17.	沈培明,徐方杰,李俊,等.二尖瓣成形治療單純二尖瓣關閉不全.中華胸心血管外科雜志,2013,29 (1):43-44.
18.	Mihos CG,Santana O,Lamas GA,et al.Incidence of postoperative atrial fibrillation in patients undergoing minimally invasive versus median sternotomyvalve surgery.J Thorac Cardiovasc Surg,2012,146 (6):1436-1441.
19.	Cheng DC,Martin J,Lal A,et al.Minimally invasive versus conventional open mitral valve surgery:a meta-analysis and systematic review.Innovations (Phila),2011,6(2):84-103.

1. ?Jokinen JJ,Hippel?inen MJ,Pitk?nen OA,et al.Mitral valve replacement versus repair propensity-adjusted survival and quality-of-life analysis.Ann Thorac Surg,2007,84 (2):451-458.
2. 金海,徐志云,于偉勇,等.微創小切口心臟瓣膜手術134例.中國胸心血管外科臨床雜志,2005,12 (4):237-239.
3. Vollroth M,Seeburger J,Garbade J,et al.Minimally invasive mitral valve surgery is a very safe procedure with very low rates of conversion to full sternotomy.Eur J Cardiothorac Surg,2012,42 (1):e13-e15.
4. Chitwood WR Jr,Elbeery JR,Moran JF.Minimally invasive mitral valve repair using transthoracic aortic occlusion.Ann Thorac Surg,1997,63 (5):1477-1479.
5. 盧聰,朱平,吳若彬,等.二尖瓣成形術631例臨床分析.南方醫科大學學報,2009,29 (3):556-558.
6. Granov N,Kacila M,Solinas M,et al.Minimally invasive mitral valve surgery through right lateral minithoracotomy--early experience of Clinical Centre of University of Sarajevo.Med Arh,2012,66 (5):357-358.
7. 陳和明,劉立明,胡建國.右胸前外側小切口微創二尖瓣置換術.中南大學學報:醫學版,2010,35 (9):1005-1008.
8. 王瀟,陶涼,陳緒發,等.右胸微創小切口二尖瓣置換術與傳統二尖瓣置換術的對比分析.中國胸心血管外科臨床雜志,2013,20 (2):139-143.
9. Aybek T,Dogan S,Wimmer-Greinecker G,et al.The micro-mitral operation comparing the Port-Access technique and the transthoracic clamp technique.J Card Surg,2000,15 (1):76-81.
10. 魏來,王春生,沈金強,等.Chitwood法微創心臟瓣膜手術115例臨床分析.中華外科雜志,2011,49 (4):373-375.
11. Pfannmüller B,Misfeld M,Borger MA,et al.Isolated reoperative minimally invasive tricuspid valve operations.Ann Thorac Surg,2012,94 (6):2005-2010.
12. Murzi M,Solinas M,Bevilacqua S,et al.A new left atrial retractor for minimally invasive mitral valve surgery.J Card Surg,2009,24 (2):175-177.
13. 謝基嚴,周清華,主譯.心胸外科學精要.第2版.天津:科技翻譯出版公司,2010.363-364.
14. 鄧學峰,高長青.二尖瓣成形術治療二尖瓣關閉不全.中國胸心血管外科臨床雜志,2008,15 (2):134-137.
15. Chen X,Turley RS,Andersen ND,et al.Minimally invasive edge-toedge mitral repair with or without artificial chordae.Ann Thorac Surg,2013,95 (4):1347-1353.
16. Bhudia SK,McCarthy PM,Smedira NG,et al.Edge-to-edge (Alfieri) mitral repair:results in diverse clinical settings.Ann Thorac Surg,2004,77 (5):1598-1606.
17. 沈培明,徐方杰,李俊,等.二尖瓣成形治療單純二尖瓣關閉不全.中華胸心血管外科雜志,2013,29 (1):43-44.
18. Mihos CG,Santana O,Lamas GA,et al.Incidence of postoperative atrial fibrillation in patients undergoing minimally invasive versus median sternotomyvalve surgery.J Thorac Cardiovasc Surg,2012,146 (6):1436-1441.
19. Cheng DC,Martin J,Lal A,et al.Minimally invasive versus conventional open mitral valve surgery:a meta-analysis and systematic review.Innovations (Phila),2011,6(2):84-103.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical Outcomes of Minimally Invasive Mitral Valvuloplasty via Right Anterolateral Minithoracotomy

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