Clinical efficacy and survival analysis of totally thoracoscopic redo mitral valve replacement_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WEI Peijian ^1,2 , LIU Jian ¹ , MA Jiexu ^1,2 , CHEN Zhao ¹ , ZHANG Yuyuan ^1,3 , TAN Tong ^1,2 , LIU Yanjun ¹ , WU Hongxiang ¹ , HUANG Huanlei ¹ , CHEN Jimei ¹ , ZHUANG Jian ¹ ,  GUO Huiming ¹

1. Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, P. R. China;
2. Shantou University Medical College, Shantou, 515041, Guangdong, P. R. China;
3. Department of Cardiovascular Surgery, Guangdong General Hospital’s Nanhai Hospital, The Second People’s Hospital of Nanhai District, Foshan, 528251, Guangdong, P. R. China;

Corresponding?author：

GUO Huiming, Email: guohuiming@gdph.org.cn

Keywords：

Redo mitral valve replacement; totally thoracoscopic; cardiopulmonary bypass; survival analysis

DOI：

10.7507/1007-4848.202104012

Video：

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Objective To analyze the clinical efficacy and survival outcome of totally thoracoscopic redo mitral valve replacement and evaluate its efficiency and safety. Methods The clinical data of patients with totally thoracoscopic redo mitral valve replacement in Guangdong Provincial People’s Hospital between 2013 and 2019 were retrospectively analyzed. Survival analysis was performed using the Kaplan-Meier method. Univariate and multivariate Cox regression analyses were used to determine the risk factors for postoperative death. Results There were 48 patients including 29 females and 19 males with a median age of 53 (44, 66) years. All the procedures were performed successfully with no conversion to median sternotomy. A total of 15, 10 and 23 patients received surgeries under non-beating heart, beating heart and ventricular fibrillation, respectively. The in-hospital mortality rate was 6.25% (3/48), and the incidence of early postoperative complications was 18.75% (9/48). Thirty-five (72.92%) patients had their tracheal intubation removed within 24 hours after the operation. The 1- and 6-year survival rates were 89.50% (95%CI 81.30%-98.70%) and 82.90% (95%CI 71.50%-96.20%), respectively. Age>65 years was an independent risk factor for postoperative death (P=0.04). Conclusion Totally thoracoscopic redo mitral valve replacement is safe and reliable, with advantages of rapid recovery, reducing blood transfusion rate, reducing postoperative complications and acceptable long-term survival rate. It is worthy of being widely popularized in the clinic.

Citation： WEI Peijian, LIU Jian, MA Jiexu, CHEN Zhao, ZHANG Yuyuan, TAN Tong, LIU Yanjun, WU Hongxiang, HUANG Huanlei, CHEN Jimei, ZHUANG Jian, GUO Huiming. Clinical efficacy and survival analysis of totally thoracoscopic redo mitral valve replacement. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(5): 731-737. doi: 10.7507/1007-4848.202104012 Copy

1.	Mehaffey HJ, Hawkins RB, Schubert S, et al. Contemporary outcomes in reoperative mitral valve surgery. Heart, 2018, 104(8): 652-656.
2.	Cohn LH. Evolution of redo cardiac surgery: Review of personal experience. J Card Surg, 2004, 19(4): 320-324.
3.	Grossi EA, Loulmet DF, Schwartz CF, et al. Evolution of operative techniques and perfusion strategies for minimally invasive mitral valve repair. J Thorac Cardiovasc Surg, 2012, 143(4Suppl): S68-S70.
4.	Grant SW, Hickey GL, Modi P, et al. Propensity-matched analysis of minimally invasive approach versus sternotomy for mitral valve surgery. Heart, 2019, 105(10): 783-789.
5.	Liu J, Chen B, Zhang YY, et al. Mitral valve replacement via minimally invasive totally thoracoscopic surgery versus traditional median sternotomy: A propensity score matched comparative study. Ann Transl Med, 2019, 7(14): 341.
6.	Cao H, Zhou Q, Fan F, et al. Right anterolateral thoracotomy: An attractive alternative to repeat sternotomy for high-risk patients undergoing reoperative mitral and tricuspid valve surgery. J Cardiothorac Surg, 2017, 12(1): 85.
7.	Cao H, Zhou Q, Xue Y, et al. Mitral valve surgery via a right infra-axillary thoracotomy in high-risk reoperative patients. Heart Surg Forum, 2020, 23(2): E200-E204.
8.	Monsefi N, ?ztürk M, Shavahatli T, et al. Right mini-thoracotomy approach in patients undergoing redo mitral valve procedure. Indian J Thorac Cardiovasc Surg, 2020, 36(6): 591-597.
9.	曹海龍, 周慶, 王東進. 右側乳緣下切口在再次瓣膜手術中的應用. 中國胸心血管外科臨床雜志, 2018, 25(3): 262-264.
10.	蔣輝, 葛建軍, 趙智偉. 胸腔鏡輔助心臟不停跳下微創再次二尖瓣手術的臨床研究. 重慶醫學, 2014, 43(25): 3339-3340.
11.	李少珂, 劉博, 左龍, 等. 3D 胸腔鏡在再次二尖瓣/三尖瓣手術中的應用. 中國心血管病研究, 2021, 19(1): 11-15.
12.	Seeburger J, Borger MA, Falk V, et al. Minimally invasive mitral valve surgery after previous sternotomy: Experience in 181 patients. Ann Thorac Surg, 2009, 87(3): 709-714.
13.	Modi P, Hassan A, Chitwood WR. Minimally invasive mitral valve surgery: A systematic review and meta-analysis. Eur J Cardiothorac Surg, 2008, 34(5): 943-952.
14.	Gammie JS, Zhao Y, Peterson ED, et al. J. Maxwell Chamberlain Memorial Paper for adult cardiac surgery. Less-invasive mitral valve operations: Trends and outcomes from the Society of Thoracic Surgeons Adult Cardiac Surgery Database. Ann Thorac Surg, 2010, 90(5): 1401-1408.
15.	Lange R, Voss B, Kehl V, et al. Right minithoracotomy versus full sternotomy for mitral valve repair: A propensity matched comparison. Ann Thorac Surg, 2017, 103(2): 573-579.
16.	魏來, 陳楠, 楊曄, 等. 2019 年度中國微創心血管外科手術統計. 中國胸心血管外科臨床雜志, 2021, 28(2): 149-153.
17.	Daemen JHT, Heuts S, Olsthoorn JR, et al. Right minithoracotomy versus median sternotomy for reoperative mitral valve surgery: A systematic review and meta-analysis of observational studies. Eur J Cardiothorac Surg, 2018, 54(5): 817-825.
18.	龍翔, 吳永兵, 朱書強, 等. 胸腔鏡輔助右側小切口在二次心臟瓣膜手術中的應用. 中國老年學雜志, 2017, 37(14): 3547-3548.
19.	楊兆華, 楊守國, 陳昊, 等. 右胸前外側小切口在再次二尖瓣手術中的應用及療效分析. 中華胸心血管外科雜志, 2014, 30(11): 674-676.
20.	何維來, 李鑫, 車轟, 等. 再次心臟房室瓣手術的微創化探索. 中國胸心血管外科臨床雜志, 2022, 29(6): 755-760.
21.	Dobell AR, Jain AK. Catastrophic hemorrhage during redo sternotomy. Ann Thorac Surg, 1984, 37(4): 273-278.
22.	Loop FD. Catastrophic hemorrhage during sternal reentry. Ann Thorac Surg, 1984, 37(4): 271-272.
23.	Losenno KL, Jones PM, Valdis M, et al. Higher-risk mitral valve operations after previous sternotomy: Endoscopic, minimally invasive approach improves patient outcomes. Can J Surg, 2016, 59(6): 399-406.
24.	Kitamura T, Stuklis RG, Edwards J. Redo mitral valve operation via right minithoracotomy—"no touch" technique. Int Heart J, 2011, 52(2): 107-109.
25.	Romano MA, Haft JW, Pagani FD, et al. Beating heart surgery via right thoracotomy for reoperative mitral valve surgery: A safe and effective operative alternative. J Thorac Cardiovasc Surg, 2012, 144(2): 334-339.
26.	Hiraoka A, Kuinose M, Totsugawa T, et al. Mitral valve reoperation under ventricular fibrillation through right mini-thoracotomy using three-dimensional videoscope. J Cardiothorac Surg, 2013, 8: 81.
27.	鐘執文, 雷遷, 張曉慎, 等. 胸腔鏡再次心臟瓣膜手術的體外循環管理. 實用醫院臨床雜志, 2016, 13(1): 16-19.
28.	Ad N, Holmes SD, Shuman DJ, et al. Minimally invasive mitral valve surgery without aortic cross-clamping and with femoral cannulation is not associated with increased risk of stroke compared with traditional mitral valve surgery: A propensity score-matched analysis. Eur J Cardiothorac Surg, 2015, 48(6): 868-872.

1. Mehaffey HJ, Hawkins RB, Schubert S, et al. Contemporary outcomes in reoperative mitral valve surgery. Heart, 2018, 104(8): 652-656.
2. Cohn LH. Evolution of redo cardiac surgery: Review of personal experience. J Card Surg, 2004, 19(4): 320-324.
3. Grossi EA, Loulmet DF, Schwartz CF, et al. Evolution of operative techniques and perfusion strategies for minimally invasive mitral valve repair. J Thorac Cardiovasc Surg, 2012, 143(4Suppl): S68-S70.
4. Grant SW, Hickey GL, Modi P, et al. Propensity-matched analysis of minimally invasive approach versus sternotomy for mitral valve surgery. Heart, 2019, 105(10): 783-789.
5. Liu J, Chen B, Zhang YY, et al. Mitral valve replacement via minimally invasive totally thoracoscopic surgery versus traditional median sternotomy: A propensity score matched comparative study. Ann Transl Med, 2019, 7(14): 341.
6. Cao H, Zhou Q, Fan F, et al. Right anterolateral thoracotomy: An attractive alternative to repeat sternotomy for high-risk patients undergoing reoperative mitral and tricuspid valve surgery. J Cardiothorac Surg, 2017, 12(1): 85.
7. Cao H, Zhou Q, Xue Y, et al. Mitral valve surgery via a right infra-axillary thoracotomy in high-risk reoperative patients. Heart Surg Forum, 2020, 23(2): E200-E204.
8. Monsefi N, ?ztürk M, Shavahatli T, et al. Right mini-thoracotomy approach in patients undergoing redo mitral valve procedure. Indian J Thorac Cardiovasc Surg, 2020, 36(6): 591-597.
9. 曹海龍, 周慶, 王東進. 右側乳緣下切口在再次瓣膜手術中的應用. 中國胸心血管外科臨床雜志, 2018, 25(3): 262-264.
10. 蔣輝, 葛建軍, 趙智偉. 胸腔鏡輔助心臟不停跳下微創再次二尖瓣手術的臨床研究. 重慶醫學, 2014, 43(25): 3339-3340.
11. 李少珂, 劉博, 左龍, 等. 3D 胸腔鏡在再次二尖瓣/三尖瓣手術中的應用. 中國心血管病研究, 2021, 19(1): 11-15.
12. Seeburger J, Borger MA, Falk V, et al. Minimally invasive mitral valve surgery after previous sternotomy: Experience in 181 patients. Ann Thorac Surg, 2009, 87(3): 709-714.
13. Modi P, Hassan A, Chitwood WR. Minimally invasive mitral valve surgery: A systematic review and meta-analysis. Eur J Cardiothorac Surg, 2008, 34(5): 943-952.
14. Gammie JS, Zhao Y, Peterson ED, et al. J. Maxwell Chamberlain Memorial Paper for adult cardiac surgery. Less-invasive mitral valve operations: Trends and outcomes from the Society of Thoracic Surgeons Adult Cardiac Surgery Database. Ann Thorac Surg, 2010, 90(5): 1401-1408.
15. Lange R, Voss B, Kehl V, et al. Right minithoracotomy versus full sternotomy for mitral valve repair: A propensity matched comparison. Ann Thorac Surg, 2017, 103(2): 573-579.
16. 魏來, 陳楠, 楊曄, 等. 2019 年度中國微創心血管外科手術統計. 中國胸心血管外科臨床雜志, 2021, 28(2): 149-153.
17. Daemen JHT, Heuts S, Olsthoorn JR, et al. Right minithoracotomy versus median sternotomy for reoperative mitral valve surgery: A systematic review and meta-analysis of observational studies. Eur J Cardiothorac Surg, 2018, 54(5): 817-825.
18. 龍翔, 吳永兵, 朱書強, 等. 胸腔鏡輔助右側小切口在二次心臟瓣膜手術中的應用. 中國老年學雜志, 2017, 37(14): 3547-3548.
19. 楊兆華, 楊守國, 陳昊, 等. 右胸前外側小切口在再次二尖瓣手術中的應用及療效分析. 中華胸心血管外科雜志, 2014, 30(11): 674-676.
20. 何維來, 李鑫, 車轟, 等. 再次心臟房室瓣手術的微創化探索. 中國胸心血管外科臨床雜志, 2022, 29(6): 755-760.
21. Dobell AR, Jain AK. Catastrophic hemorrhage during redo sternotomy. Ann Thorac Surg, 1984, 37(4): 273-278.
22. Loop FD. Catastrophic hemorrhage during sternal reentry. Ann Thorac Surg, 1984, 37(4): 271-272.
23. Losenno KL, Jones PM, Valdis M, et al. Higher-risk mitral valve operations after previous sternotomy: Endoscopic, minimally invasive approach improves patient outcomes. Can J Surg, 2016, 59(6): 399-406.
24. Kitamura T, Stuklis RG, Edwards J. Redo mitral valve operation via right minithoracotomy—"no touch" technique. Int Heart J, 2011, 52(2): 107-109.
25. Romano MA, Haft JW, Pagani FD, et al. Beating heart surgery via right thoracotomy for reoperative mitral valve surgery: A safe and effective operative alternative. J Thorac Cardiovasc Surg, 2012, 144(2): 334-339.
26. Hiraoka A, Kuinose M, Totsugawa T, et al. Mitral valve reoperation under ventricular fibrillation through right mini-thoracotomy using three-dimensional videoscope. J Cardiothorac Surg, 2013, 8: 81.
27. 鐘執文, 雷遷, 張曉慎, 等. 胸腔鏡再次心臟瓣膜手術的體外循環管理. 實用醫院臨床雜志, 2016, 13(1): 16-19.
28. Ad N, Holmes SD, Shuman DJ, et al. Minimally invasive mitral valve surgery without aortic cross-clamping and with femoral cannulation is not associated with increased risk of stroke compared with traditional mitral valve surgery: A propensity score-matched analysis. Eur J Cardiothorac Surg, 2015, 48(6): 868-872.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical efficacy and survival analysis of totally thoracoscopic redo mitral valve replacement

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