Port-access Minimally Invasive versus Conventional Approach for Mitral Valve Surgery: A Randomized Controlled Trial_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

QIUZhi-bing ,  CHENXin , YANGTing , XUMing , WANGLi-ming , HUANGFu-hua , JIANGying-shuo , XIAOLiqiong , ZHANGYang-bo

Department of Cardiovascular Surgery, Nanjing Hospital Affiliated to Nanjing Medical University, Nanjing First Hospital, Nanjing 210006, P. R. China;

Corresponding?author：

CHENXin, Email: stevecx1@163.com

Keywords：

Minimally invasive surgery; Port-access cardiopulmonary bypass; Mitral valve surgery; Small incision; Randomized controlled trial

DOI：

10.7507/1007-4848.20150002

Video：

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Objective To 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. Methods From 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. Results There 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). Conclusion MIMVS 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.

Citation： QIUZhi-bing, CHENXin, YANGTing, XUMing, WANGLi-ming, HUANGFu-hua, JIANGying-shuo, XIAOLiqiong, ZHANGYang-bo. Port-access Minimally Invasive versus Conventional Approach for Mitral Valve Surgery: A Randomized Controlled Trial. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(1): 4-8. doi: 10.7507/1007-4848.20150002 Copy

1.	?Colangelo N, Torracca L, Lapenna E, et al. Vacuum-assisted venous drainage in extrathoracic cardiopulmonary bypass management during minimally invasive cardiac surgery. Perfusion, 2006, 21(6):361-365.
2.	Kiaii B, Bainbridge D, Fernandes P. Surgical, anesthetic, perfusionrelated advances in minimal access surgery. Semin Cardiothorac Vasc Anesth, 2007, 11(4):282-287.
3.	Chitwood WR Jr, Elbeery JR, Moran JF. Minimally invasive mitral valve repair using transthoracic aortic occlusion. Ann Thorac Surg, 1997, 63(5):1477-1479.
4.	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.
5.	Chitwood WR. Minimally invasive valve surgery:trends for the future. Euro J Cardiothoracic Surg, 1999, 16(Suppl 1):S64-S65.
6.	Modi P, Hassan A, Chitwood WR. Minimally invasive mitral valve surgery:a systematic review and meta-analysis. Euro J Cardiothoracic Surg, 2008, 34(5):943-952.
7.	Walther T, Falk V, Mohr FW. Minimally invasive surgery for valve disease. Curr Prob Cardiol, 2006, 31(6):399-437.
8.	Dogan S, Aybek T, Risteski PS, et al. Minimally invasive port access versus conventional mitral valve surgery:prospective randomized study. Ann Thorac Surg 2005, 79(2):492-498.
9.	Iribarne A, Russo MJ, Easterwood R, et al. Minimally invasive versus sternotomy approach for mitral valve surgery:a propensity analysis. Ann Thorac Surg, 2010, 90(5):1471-1477.
10.	Soltesz EG, Cohn LH. Minimally invasive valve surgery. Cardiol Rev, 2007, 15(3):109-115.
11.	Welp H, Martens S. Minimally invasive mitral valve repair. Curr Opin Anaesthesiol, 2014, 27(1):65-71.
12.	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.
13.	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.
14.	陳海生, 冼明海, 程云閣, 等. 經股動靜脈插管建立體外循環行電視胸腔鏡與心內直視手術138 例. 中國胸心血管外科臨床雜志, 2005, 12(5):361-362.
15.	師恩祎, 谷天祥, 喻磊, 等. 微創與常規二尖瓣成形和置換術治療單純二尖瓣病變患者的病例對照研究. 中國胸心血管外科臨床雜志, 2013, 20(3):294-297.
16.	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.
17.	Ryan WH, Brinkman WT, Dewey TM, et al. Mitral valve surgery:comparison of outcomes in matched sternotomy and port access groups. J Heart Valve Dis, 2010, 19(1):51-58.
18.	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.
19.	Baumbach H, Rustenbach C, Michaelsen J, et al. Minimally invasive versus conventional extracorporeal circulation in minimally invasive cardiac valve surgery. Thorac Cardiovasc Surg, 2014, 62(1):42-46.
20.	Cohn LH, Byrne JG. Minimally invasive mitral valve surgery:current status. Tex Heart Inst J, 2013, 40(5):575-576.

1. ?Colangelo N, Torracca L, Lapenna E, et al. Vacuum-assisted venous drainage in extrathoracic cardiopulmonary bypass management during minimally invasive cardiac surgery. Perfusion, 2006, 21(6):361-365.
2. Kiaii B, Bainbridge D, Fernandes P. Surgical, anesthetic, perfusionrelated advances in minimal access surgery. Semin Cardiothorac Vasc Anesth, 2007, 11(4):282-287.
3. Chitwood WR Jr, Elbeery JR, Moran JF. Minimally invasive mitral valve repair using transthoracic aortic occlusion. Ann Thorac Surg, 1997, 63(5):1477-1479.
4. 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.
5. Chitwood WR. Minimally invasive valve surgery:trends for the future. Euro J Cardiothoracic Surg, 1999, 16(Suppl 1):S64-S65.
6. Modi P, Hassan A, Chitwood WR. Minimally invasive mitral valve surgery:a systematic review and meta-analysis. Euro J Cardiothoracic Surg, 2008, 34(5):943-952.
7. Walther T, Falk V, Mohr FW. Minimally invasive surgery for valve disease. Curr Prob Cardiol, 2006, 31(6):399-437.
8. Dogan S, Aybek T, Risteski PS, et al. Minimally invasive port access versus conventional mitral valve surgery:prospective randomized study. Ann Thorac Surg 2005, 79(2):492-498.
9. Iribarne A, Russo MJ, Easterwood R, et al. Minimally invasive versus sternotomy approach for mitral valve surgery:a propensity analysis. Ann Thorac Surg, 2010, 90(5):1471-1477.
10. Soltesz EG, Cohn LH. Minimally invasive valve surgery. Cardiol Rev, 2007, 15(3):109-115.
11. Welp H, Martens S. Minimally invasive mitral valve repair. Curr Opin Anaesthesiol, 2014, 27(1):65-71.
12. 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.
13. 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.
14. 陳海生, 冼明海, 程云閣, 等. 經股動靜脈插管建立體外循環行電視胸腔鏡與心內直視手術138 例. 中國胸心血管外科臨床雜志, 2005, 12(5):361-362.
15. 師恩祎, 谷天祥, 喻磊, 等. 微創與常規二尖瓣成形和置換術治療單純二尖瓣病變患者的病例對照研究. 中國胸心血管外科臨床雜志, 2013, 20(3):294-297.
16. 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.
17. Ryan WH, Brinkman WT, Dewey TM, et al. Mitral valve surgery:comparison of outcomes in matched sternotomy and port access groups. J Heart Valve Dis, 2010, 19(1):51-58.
18. 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.
19. Baumbach H, Rustenbach C, Michaelsen J, et al. Minimally invasive versus conventional extracorporeal circulation in minimally invasive cardiac valve surgery. Thorac Cardiovasc Surg, 2014, 62(1):42-46.
20. Cohn LH, Byrne JG. Minimally invasive mitral valve surgery:current status. Tex Heart Inst J, 2013, 40(5):575-576.

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Port-access Minimally Invasive versus Conventional Approach for Mitral Valve Surgery: A Randomized Controlled Trial

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