A comparative study of mitral valve replacement by right 3rd intercostal small incision and traditional median thoracotomy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

GAO Yang ,  QIAO Yanli , CHEN Qingwei , CHEN Guoqing , YAN Lei

Department of Cardiovascular Surgery, Affiliated Hospital of Jining Medical College, Jining, 272029, Shandong, P.R.China;

Corresponding?author：

QIAO Yanli, Email: yanliq802@aliyun.com

Keywords：

Mitral valve replacement; later thoracotomy; median thoracotomy

DOI：

10.7507/1007-4848.201903028

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To compare the safety and efficacy of simple mitral valve replacement with the third intercostal incision on the right side and the conventional midsternum incision.Methods From February 2017 to February 2019, heart surgery in the Affiliated Hospital of Jining Medical College completed the first simple mitral valve replacement (MVR) operation in 103 patients, of whom 39 patients were received minimally invasive right third intercostal small incision (a minimally invasive surgery group). There were 10 males, 29 females at average age of 59.51 years. There were 64 patients with MVR via the middle section of the common sternum (a conventional surgery group), 22 males and 42 females, with an average age of 60.22 years. Types of lesions: 65 patients were with mitral stenosis, 22 patients with incomplete closure, 16 patients with incomplete closure.Results There was no significant difference in preoperative clinical data between the two groups (P>0.05). The entire group of patients successfully completed the operation. Surgical replacement of mitral valve mechanical valve in 74 patients and biological valve in 29 patients. There was no significant difference between the two groups in the extracardiopulmonary cycle time, aortic blockade time and total hospitalization time. In the early stage of operation, 3 patients were examined for secondary hemostasis, 1 patient was minimally invasive surgery, and the remaining 2 patients were with routine surgery. The infection of incision occurred in 3 patients, all of them were in the routine operation group. All three patients died early after operation in the routine operation group: two were postoperative low cardiac volumetric syndrome leading to multiple organ failure, and the other was sternum infection accompanied by artificial valve endocarditis.Conclusion There is no significant difference between MVR through the third rib of the right chest and traditional MVR in the safety. However, it has the advantages of small trauma, beauty, low incidence of incision infection and reduced postoperative pain.

Citation： GAO Yang, QIAO Yanli, CHEN Qingwei, CHEN Guoqing, YAN Lei. A comparative study of mitral valve replacement by right 3rd intercostal small incision and traditional median thoracotomy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(12): 1204-1207. doi: 10.7507/1007-4848.201903028 Copy

1.	Iribarne A, Easterwood R, Chan EY, et al. The golden age of minimally invasive cardiothoracic surgery: current and future perspective. Future Cardiol, 2011, 7: 333-346.
2.	Fortunato Junior JA, Fernandes AG, Sesca JR, et al. Minimally in vasive aortic valve replacement: an alternative to the conventional technique. Rev Bras Cir Cardiovasc, 2012, 27(4): 570-582.
3.	王齊敏, 陳道中, 方冠華, 等. 胸腔鏡輔助右胸小切口二尖瓣置換術(附 45 例報告). 中國微創外科雜志, 2013, 13(10): 944-945.
4.	Bouhout I, Morgant MC, Bouchard D. Minimally invasive heart valve surger. Can J Cardiol, 2017, 33(9): 1129-1137.
5.	Easterwood RM, Bostock IC, Nammalwar S, et al. The evolution of minimally invasive cardiac surgery: from minimal access to transcatheter approaches. Future Cardiol, 2018, 14(1): 75-87.
6.	Mazine A, Vistarini N, Ghoneim A, et al. Very high repair rate using minimally invasive surgery for the treatment of degenerative mitral in sufficiency. Can J Cardiol, 2015, 31: 744-751.
7.	吳永兵, 周建良, 張小強, 等. 電視胸腔鏡輔助下微創二尖瓣手術 42 例. 江西醫藥, 2012, 47(4): 289-291.
8.	王瀟, 陶良, 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(4): 139-141.
9.	喬衍禮, 安國營, 張洪宇, 等. 右腋下小切口體外循環心內直視手術 270 例. 中國胸心血管外科臨床雜志, 2012, 19(5): 565-566.
10.	喬衍禮, 倪良春, 鄭善光, 等. 完全電視胸腔鏡下心臟手術 108 例. 中華胸心血管外科雜志, 2012, 28(4): 207-208.
11.	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.
12.	Pojar M, Vojacek J, Karalko M, et al. Single-center experience with minimally invasive mitral operations through right minithoracotomy. Ann Thorac Cardiovasc Surg, 2019, 25(1): 18-25.
13.	尤斌, 高峰, 李平, 等. 保持胸廓完整性的右前外胸部小切口手術治療心臟多瓣膜病變. 中國微創外科雜志, 2013, 13(5): 452-454.
14.	Wang Q, Xue X, Yang J, et al. Right mini-thoracotomy approach reduces hospital stay and transfusion of mitral or tricuspid valve reoperation with non-inferior efficacy: evidence from propensity-matched study. J Thorac Dis, 2018, 10(8): 4789-4800.
15.	張致琦, 趙東, 朱仕杰, 等. 12 例右胸骨旁第 3 肋間小切口行三瓣膜手術的臨床經驗. 復旦學報 (醫學版), 2015, 42(2): 222-225.
16.	王東進, 武忠, 曹彬, 等. 右腋下小切口二尖瓣、主動脈瓣雙瓣膜置換術 28 例. 中國胸心血管外科臨床雜志, 2004, 11(4): 295-297.

1. Iribarne A, Easterwood R, Chan EY, et al. The golden age of minimally invasive cardiothoracic surgery: current and future perspective. Future Cardiol, 2011, 7: 333-346.
2. Fortunato Junior JA, Fernandes AG, Sesca JR, et al. Minimally in vasive aortic valve replacement: an alternative to the conventional technique. Rev Bras Cir Cardiovasc, 2012, 27(4): 570-582.
3. 王齊敏, 陳道中, 方冠華, 等. 胸腔鏡輔助右胸小切口二尖瓣置換術(附 45 例報告). 中國微創外科雜志, 2013, 13(10): 944-945.
4. Bouhout I, Morgant MC, Bouchard D. Minimally invasive heart valve surger. Can J Cardiol, 2017, 33(9): 1129-1137.
5. Easterwood RM, Bostock IC, Nammalwar S, et al. The evolution of minimally invasive cardiac surgery: from minimal access to transcatheter approaches. Future Cardiol, 2018, 14(1): 75-87.
6. Mazine A, Vistarini N, Ghoneim A, et al. Very high repair rate using minimally invasive surgery for the treatment of degenerative mitral in sufficiency. Can J Cardiol, 2015, 31: 744-751.
7. 吳永兵, 周建良, 張小強, 等. 電視胸腔鏡輔助下微創二尖瓣手術 42 例. 江西醫藥, 2012, 47(4): 289-291.
8. 王瀟, 陶良, 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(4): 139-141.
9. 喬衍禮, 安國營, 張洪宇, 等. 右腋下小切口體外循環心內直視手術 270 例. 中國胸心血管外科臨床雜志, 2012, 19(5): 565-566.
10. 喬衍禮, 倪良春, 鄭善光, 等. 完全電視胸腔鏡下心臟手術 108 例. 中華胸心血管外科雜志, 2012, 28(4): 207-208.
11. 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.
12. Pojar M, Vojacek J, Karalko M, et al. Single-center experience with minimally invasive mitral operations through right minithoracotomy. Ann Thorac Cardiovasc Surg, 2019, 25(1): 18-25.
13. 尤斌, 高峰, 李平, 等. 保持胸廓完整性的右前外胸部小切口手術治療心臟多瓣膜病變. 中國微創外科雜志, 2013, 13(5): 452-454.
14. Wang Q, Xue X, Yang J, et al. Right mini-thoracotomy approach reduces hospital stay and transfusion of mitral or tricuspid valve reoperation with non-inferior efficacy: evidence from propensity-matched study. J Thorac Dis, 2018, 10(8): 4789-4800.
15. 張致琦, 趙東, 朱仕杰, 等. 12 例右胸骨旁第 3 肋間小切口行三瓣膜手術的臨床經驗. 復旦學報 (醫學版), 2015, 42(2): 222-225.
16. 王東進, 武忠, 曹彬, 等. 右腋下小切口二尖瓣、主動脈瓣雙瓣膜置換術 28 例. 中國胸心血管外科臨床雜志, 2004, 11(4): 295-297.

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A comparative study of mitral valve replacement by right 3rd intercostal small incision and traditional median thoracotomy

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