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《Chinese Journal of Cardiovascular Research》 2018-04
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A propensity score matched study of minimally invasive aortic valve replacement through right anterior minithoracotomy

ZHU Jia-quan;BAO Chun-rong;ZHANG Jun-wen;MEI Ju;Department of Cardiothoracic Surgery,Xinhua Hospital,Shanghai Jiaotong University School of Medicine;  
Objective To summarize the techniques and results of minimally invasive aortic valve replacement(A VR) through right anterior mini thoracotomy. Methods Patients with isolated aortic valve replacement from January 2010 to June 2017 were retrospectively reviewed. They were divided into two groups, the minimally invasive AVR group through right anterior minithoracotomy(MIAVR, n=65), and conventional AVR group from sternotomy(CAVR, n=182). Patients with ministernotomy were excluded. In MIAVR group, the cardiopulmonary bypass was established by peripheral cannulation from femoral artery and vein, A right parasternal transverse incision from the third intercostal space was used, and the aortic valve replacement was performed through the small incision. A logistic model was used in the propensity score matching(PSM) methods; gender, age, etiology of aortic valve, ejection fraction, and NYHA heart function were adjusted in the model. The matching ratio is one to one. The influence of minimally invasive techniques in the clinical outcomes of AVR was evaluated. Results There were 3 deaths, and all of them belonged to CAVR group(3/182, 1.6%). There was no transition to sternotomy and no reoperation in the MIAVR group. After propensity score matching,the new control group(PSMCAVR group) contained 65 patients, who had similar pre-operative baseline data as the MIAVR group. When compared to PSM-CAVR group, the cardiopulmonary bypass time and cross clamp time were significantly longer[(103.6±37.2)min vs.(88.3±27.2)min,P=0.01,(68.3±18.6)min vs.(48.8±18.9)min,P0.01]. In the MIAVR group, the length of ICU stay was(1.9±0.4)days,and the post-operative hospital stay time was(8.4±1.8)days,which were significantly lower than PSM-CAVR group [(2.4±0.9)d vs.(10.6±3.2)d, P0.01]. The pleural drainage during the first post-operative day was less in MIAVR group than that in PSM-AVR group [(281 ±53)ml vs.(432±88)ml,P0.01 ]. No differences of mortality, deep wound infection and transfusion rate were found between the groups(0% vs. 1.5%, P=0.32, 0% vs. 3.1%, P=0.15; 23.1% vs. 35.4%, P=0.13). Conclusion Minimally invasive aortic valve replacement from right anterior minithoracotomy is feasible and safe. Despite the procedure increases cardiopulmonary bypass time and cross clamp time, it can reduce drainage and facilitate post-operative recovery.
【Fund】: 国家临床重点专科项目;; 国家自然科学基金(项目编号:81600219);; 新华医院临床重点基金(项目编号:15LC03)
【CateGory Index】: R654.2
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