Right Minithoracotomy versus Conventional Median Sternotomy for Patients Undergoing Mitral Valve Surgery Combined with Tricuspid Valve Surgery: A Case Control Study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

JIANGZhao-lei ,  MEIJǔ , DINGFang-bao , MANan , ZHANGJun-wen , LIUHao , HeYi , YINHang

Department of Cardiothoracic Surgery Xinhua Hospital, School of Medicine, Shanghai Jiaotong University;Shanghai 200092, P. R. China;

Corresponding?author：

MEIJǔ, Email: ju_mei63@126.com

Keywords：

Minimally invasive surgery; Mitral valve surgery; Tricuspid valve surgery

DOI：

10.7507/1007-4848.20150164

Video：

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Objective To compare the outcomes of concomitant mitral valve surgery and tricuspid valve surgery through right minithoracotomy and conventional median sternotomy approaches. Methods We retrospectively analyzed clinical data of 475 patients underwent mitral valve surgery combined with tricuspid valve surgery through right minithoracotomy or conventional median sternotomy in Xinhua Hospital between June 2006 and June 2013. The patients were divided into two groups including a minimally invasive group(116 patients) and a conventional group (359 patients). Results All the patients successfully underwent mitral valve and tricuspid valve surgery. During operation, there were 426 patients with no trivial mitral regurgitation (MR) and 49 patients with trivial MR. There were 282 patients with no tricuspid regurgitation (TR) and 193 patients with trivil TR. At discharge, transesophageal echocardiography showed that trivial MR in 38 patients, mild MR in 5 patients, trivial tricuspid regurgitation (TR) in 150 patients and mild TR in 7 patients. There was no significant difference between the two groups in complications. Conclusion Right minithoracotomy can achieve the similar therapeutic effect to conventional median sternotomy for patients with mitral valve disease and concomitant tricuspid valve disease. In addition, patients through right minithoracotomy had better cosmetic outcomes.

Citation： JIANGZhao-lei, MEIJǔ, DINGFang-bao, MANan, ZHANGJun-wen, LIUHao, HeYi, YINHang. Right Minithoracotomy versus Conventional Median Sternotomy for Patients Undergoing Mitral Valve Surgery Combined with Tricuspid Valve Surgery: A Case Control Study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(7): 646-649. doi: 10.7507/1007-4848.20150164 Copy

1.	Mariscalco G, Musumeci F. The minithoracotomy approach:a safe and effective alternative for heart valve surgery. Ann Thorac Surg, 2014, 97(1):356-64.
2.	Soltesz EG, Cohn LH. Minimally invasive valve surgery. Cardiol Rev, 2007,15(3):109-115.
3.	王東進, 吳清玉, 楊秀濱, 等. 右腋下直切口在體外循環心臟直視手術中的應用. 中國胸心血管外科臨床雜志, 2007, 14(6):468-470.
4.	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.
5.	姜兆磊, 朱家全, 梅舉, 等. 腔靜脈內阻斷技術在單純性三尖瓣微創手術中的應用. 中國心血管病研究, 2013, 11(8):564-567.
6.	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.
7.	Ward AF, Grossi EA, Galloway AC. Minimally invasive mitral surgery through right mini-thoracotomy under direct vision. J Thorac Dis, 2013, 5(Suppl 6):S673-S679.
8.	Goldstone AB, Atluri P, Szeto WY, et al. Minimally invasive approach provides at least equivalent results for surgical correction of mitral regurgitation:a propensity-matched comparison. J Thorac Cardiovasc Surg, 2013, 145(3):S748-756.
9.	魏來, 沈金強, 王春生, 等. 三種入路行二尖瓣后葉成形手術近中期療效比較. 中華外科雜志, 2012, 50(7):637-641.
10.	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.
11.	Svensson LG, Atik FA, Cosgrove DM, et al. Minimally invasive versus conventional mitral valve surgery:a propensity-matched comparison. J Thorac Cardiovasc Surg, 2010, 139(4):926-932.e1-e2.
12.	Davierwala PM, Seeburger J, Pfannmueller B, et al. Minimally invasive mitral valve surgery:"The Leipzig experience". Ann Cardiothorac Surg, 2013, 2(6):744-750.
13.	Iribarne A, Easterwood R, Russo MJ, et al. Comparative effectiveness of minimally invasive versus traditional sternotomy mitral valve surgery in elderly patients. J Thorac Cardiovasc Surg, 2012, 143(4 Suppl):S86-90.
14.	McClure RS, Athanasopoulos LV, McGurk S, et al. One thousand minimally invasive mitral valve operations:early outcomes, late outcomes, and echocardiographic follow-up. J Thorac Cardiovasc Surg, 2013, 145(5):1199-1206.
15.	劉寶玉, 姜建青, 周凱, 等. 風濕性二尖瓣、主動脈瓣與三尖瓣聯合病變的外科治療. 中國胸心血管外科臨床雜志, 2005, 12(4):287-288.
16.	薛清, 徐志云, 韓林, 等. 二尖瓣成形術中輕度功能性三尖瓣反流的處理. 中國胸心血管外科臨床雜志, 2011, 18(6):503-506.
17.	Shiran A, Sagie A. Tricuspid regurgitation in mitral valve disease incidence,prognostic implications,mechanism,and management. J Am Coll Cardiol, 2009, 53(5):401-408.
18.	Jiang Z, Mei J, Ding F, et al. Application of endovascular occlusion of both caval veins in minimally invasive isolated redo tricuspid surgery through right thoracotomy. Heart Lung Circ, 2014, 23(2):186-189.
19.	Lawrance CP, Henn MC, Miller JR, et al. A minimally invasive Cox maze IV procedure is as effective as sternotomy while decreasing major morbidity and hospital stay. J Thorac Cardiovasc Surg, 2014, 148(3):955-961.
20.	Lee AM, Clark K, Bailey MS, et al. A minimally invasive cox-maze procedure:operative technique and results. Innovations (Phila), 2010, 5(4):281-286.

1. Mariscalco G, Musumeci F. The minithoracotomy approach:a safe and effective alternative for heart valve surgery. Ann Thorac Surg, 2014, 97(1):356-64.
2. Soltesz EG, Cohn LH. Minimally invasive valve surgery. Cardiol Rev, 2007,15(3):109-115.
3. 王東進, 吳清玉, 楊秀濱, 等. 右腋下直切口在體外循環心臟直視手術中的應用. 中國胸心血管外科臨床雜志, 2007, 14(6):468-470.
4. 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.
5. 姜兆磊, 朱家全, 梅舉, 等. 腔靜脈內阻斷技術在單純性三尖瓣微創手術中的應用. 中國心血管病研究, 2013, 11(8):564-567.
6. 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.
7. Ward AF, Grossi EA, Galloway AC. Minimally invasive mitral surgery through right mini-thoracotomy under direct vision. J Thorac Dis, 2013, 5(Suppl 6):S673-S679.
8. Goldstone AB, Atluri P, Szeto WY, et al. Minimally invasive approach provides at least equivalent results for surgical correction of mitral regurgitation:a propensity-matched comparison. J Thorac Cardiovasc Surg, 2013, 145(3):S748-756.
9. 魏來, 沈金強, 王春生, 等. 三種入路行二尖瓣后葉成形手術近中期療效比較. 中華外科雜志, 2012, 50(7):637-641.
10. 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.
11. Svensson LG, Atik FA, Cosgrove DM, et al. Minimally invasive versus conventional mitral valve surgery:a propensity-matched comparison. J Thorac Cardiovasc Surg, 2010, 139(4):926-932.e1-e2.
12. Davierwala PM, Seeburger J, Pfannmueller B, et al. Minimally invasive mitral valve surgery:"The Leipzig experience". Ann Cardiothorac Surg, 2013, 2(6):744-750.
13. Iribarne A, Easterwood R, Russo MJ, et al. Comparative effectiveness of minimally invasive versus traditional sternotomy mitral valve surgery in elderly patients. J Thorac Cardiovasc Surg, 2012, 143(4 Suppl):S86-90.
14. McClure RS, Athanasopoulos LV, McGurk S, et al. One thousand minimally invasive mitral valve operations:early outcomes, late outcomes, and echocardiographic follow-up. J Thorac Cardiovasc Surg, 2013, 145(5):1199-1206.
15. 劉寶玉, 姜建青, 周凱, 等. 風濕性二尖瓣、主動脈瓣與三尖瓣聯合病變的外科治療. 中國胸心血管外科臨床雜志, 2005, 12(4):287-288.
16. 薛清, 徐志云, 韓林, 等. 二尖瓣成形術中輕度功能性三尖瓣反流的處理. 中國胸心血管外科臨床雜志, 2011, 18(6):503-506.
17. Shiran A, Sagie A. Tricuspid regurgitation in mitral valve disease incidence,prognostic implications,mechanism,and management. J Am Coll Cardiol, 2009, 53(5):401-408.
18. Jiang Z, Mei J, Ding F, et al. Application of endovascular occlusion of both caval veins in minimally invasive isolated redo tricuspid surgery through right thoracotomy. Heart Lung Circ, 2014, 23(2):186-189.
19. Lawrance CP, Henn MC, Miller JR, et al. A minimally invasive Cox maze IV procedure is as effective as sternotomy while decreasing major morbidity and hospital stay. J Thorac Cardiovasc Surg, 2014, 148(3):955-961.
20. Lee AM, Clark K, Bailey MS, et al. A minimally invasive cox-maze procedure:operative technique and results. Innovations (Phila), 2010, 5(4):281-286.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Right Minithoracotomy versus Conventional Median Sternotomy for Patients Undergoing Mitral Valve Surgery Combined with Tricuspid Valve Surgery: A Case Control Study

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