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Minimally invasive mitral valve replacement is a safe and effective surgery for patients with rheumatic valve disease: A retrospective study.

Abstract The aim of the study was to evaluate the treatment of minimally invasive mitral valve replacement (MIMVR) through a right minithoracotomy for patients with rheumatic mitral valve disease.From February 2009 to December 2016, 360 patients with rheumatic mitral valve disease underwent mitral valve replacement by the same surgeon. Among them, 150 patients accepted MIMVR through a right minithoracotomy, whereas the other 210 accepted a traditional median sternotomy. After matching by patients by age, sex, EuroSCORE, New York Heart Association (NYHA) classification, renal and liver function, and degree of mitral valve disease, we selected 224 patients for analysis in our retrospective study.In the MIMVR group (112 patients), the aortic cross-clamp time (ACC time) (55.25 ± 2.18 minutes) was significantly longer than that in the control group (112 patients; 36.05 ± 1.40 minutes) (P < .0001). In contrast, the cardiopulmonary bypass time (CPB time) was shorter in the MIMVR group than in the control group (61.13 ± 2.57 vs 78.65 ± 4.05 minutes, respectively, P < .0001). Patients who accepted MIMVR surgery had less drainage 24 hours postoperation (324.10 ± 34.55 vs 492.90 ± 34.05 mL, P < .0001) and had less total drainage (713.46 ± 65.35 vs 990.49 ± 67.88 mL, P < .0001) than those who underwent median sternotomy. Thirty-two percent of patients in the MIMVR group needed a blood transfusion (1.35 ± .28 units of red blood cells, 155.36 ± 33.43 mL plasma), whereas 67.0% of the control group needed a blood transfusion (2.15 ± .24 units of red blood cells, 287.50 ± 33.54 mL plasma) (Ptransfusion < .001, Pcell = .029, Pplasma = .006). In total, 5 deaths occurred during the perioperative period; 3 occurred in the MIMVR group. The average hospital stay was significantly shorter in the MIMVR group than that in the control group (6.56 ± .23 vs 8.53 ± .59 days, P = .003).MIMVR, an effective and safe treatment approach for patients suffering from rheumatic mitral valve disease, is associated with less trauma and a faster recovery. It is a better choice for treating simple rheumatic mitral valve disease.
PMID
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Authors

Mayor MeshTerms

Heart Valve Prosthesis Implantation

Minimally Invasive Surgical Procedures

Keywords
Journal Title medicine
Publication Year Start




PMID- 28614262
OWN - NLM
STAT- MEDLINE
DA  - 20170614
DCOM- 20170706
LR  - 20170706
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 24
DP  - 2017 Jun
TI  - Minimally invasive mitral valve replacement is a safe and effective surgery for
      patients with rheumatic valve disease: A retrospective study.
PG  - e7193
LID - 10.1097/MD.0000000000007193 [doi]
AB  - The aim of the study was to evaluate the treatment of minimally invasive mitral
      valve replacement (MIMVR) through a right minithoracotomy for patients with
      rheumatic mitral valve disease.From February 2009 to December 2016, 360 patients 
      with rheumatic mitral valve disease underwent mitral valve replacement by the
      same surgeon. Among them, 150 patients accepted MIMVR through a right
      minithoracotomy, whereas the other 210 accepted a traditional median sternotomy. 
      After matching by patients by age, sex, EuroSCORE, New York Heart Association
      (NYHA) classification, renal and liver function, and degree of mitral valve
      disease, we selected 224 patients for analysis in our retrospective study.In the 
      MIMVR group (112 patients), the aortic cross-clamp time (ACC time) (55.25 +/-
      2.18 minutes) was significantly longer than that in the control group (112
      patients; 36.05 +/- 1.40 minutes) (P &lt; .0001). In contrast, the cardiopulmonary
      bypass time (CPB time) was shorter in the MIMVR group than in the control group
      (61.13 +/- 2.57 vs 78.65 +/- 4.05 minutes, respectively, P &lt; .0001). Patients who
      accepted MIMVR surgery had less drainage 24 hours postoperation (324.10 +/- 34.55
      vs 492.90 +/- 34.05 mL, P &lt; .0001) and had less total drainage (713.46 +/- 65.35 
      vs 990.49 +/- 67.88 mL, P &lt; .0001) than those who underwent median sternotomy.
      Thirty-two percent of patients in the MIMVR group needed a blood transfusion
      (1.35 +/- .28 units of red blood cells, 155.36 +/- 33.43 mL plasma), whereas
      67.0% of the control group needed a blood transfusion (2.15 +/- .24 units of red 
      blood cells, 287.50 +/- 33.54 mL plasma) (Ptransfusion &lt; .001, Pcell = .029,
      Pplasma = .006). In total, 5 deaths occurred during the perioperative period; 3
      occurred in the MIMVR group. The average hospital stay was significantly shorter 
      in the MIMVR group than that in the control group (6.56 +/- .23 vs 8.53 +/- .59
      days, P = .003).MIMVR, an effective and safe treatment approach for patients
      suffering from rheumatic mitral valve disease, is associated with less trauma and
      a faster recovery. It is a better choice for treating simple rheumatic mitral
      valve disease.
FAU - Zhai, Junyu
AU  - Zhai J
AD  - Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital Fudan
      University, Shanghai, China.
FAU - Wei, Lai
AU  - Wei L
FAU - Huang, Ben
AU  - Huang B
FAU - Wang, Chunsheng
AU  - Wang C
FAU - Zhang, Hongqiang
AU  - Zhang H
FAU - Yin, Kanhua
AU  - Yin K
LA  - eng
PT  - Journal Article
PT  - Observational Study
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
SB  - AIM
SB  - IM
MH  - Blood Transfusion
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Valve Diseases/mortality/*surgery
MH  - Heart Valve Prosthesis
MH  - *Heart Valve Prosthesis Implantation
MH  - Humans
MH  - Length of Stay
MH  - Male
MH  - Middle Aged
MH  - *Minimally Invasive Surgical Procedures
MH  - Mitral Valve/*surgery
MH  - Operative Time
MH  - Postoperative Complications
MH  - Propensity Score
MH  - Retrospective Studies
MH  - Rheumatic Heart Disease/mortality/*surgery
MH  - Severity of Illness Index
MH  - Thoracotomy/*methods
MH  - Treatment Outcome
EDAT- 2017/06/15 06:00
MHDA- 2017/07/07 06:00
CRDT- 2017/06/15 06:00
AID - 10.1097/MD.0000000000007193 [doi]
AID - 00005792-201706160-00048 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Jun;96(24):e7193. doi: 10.1097/MD.0000000000007193.