1
|
Shen H, Li D, Cheng N, Li L, Dong S, Shen H, Zhang L, Jiang S. Comparative efficacy of totally thoracoscopic, mini-thoracotomy, and mini-sternotomy approaches in aortic valve replacement. Sci Rep 2024; 14:17625. [PMID: 39085273 PMCID: PMC11291665 DOI: 10.1038/s41598-024-67018-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 07/08/2024] [Indexed: 08/02/2024] Open
Abstract
Aortic valve replacement (AVR) is a critical procedure for patients with aortic valve diseases. This study compares the effectiveness of three minimally-invasive surgical approaches for AVR: totally thoracoscopic (TT), right anterior mini-thoracotomy, and upper mini-sternotomy. We analyzed retrospective data from 130 patients who underwent one of these surgeries, focusing on various factors such as duration of hospital stay, operation time, times for cardiopulmonary bypass and aortic cross-clamping, postoperative complications, levels of cardiac biomarkers, pain intensity using the Visual Analog Scale, and mid-term survival rates. Results show that while the TT method had the longest operation times, it also had the shortest hospital stays and faster pain reduction post-surgery. Although the TT group initially showed higher cardiac biomarker levels after surgery, these levels normalized by the third day, similar to the other groups. There were no significant differences in mid-term survival and major adverse cardiac and cerebrovascular event (MACCE) rates among the groups. These findings suggest that the TT method, despite longer surgical times, offers a quicker initial recovery, making it a viable option for AVR.
Collapse
Affiliation(s)
- Hua Shen
- Department of Cardiovascular Surgery, The First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing, 100853, China
- Department of Adult Cardiac Surgery, The Sixth Medical Center of PLA General Hospital, Beijing, 100048, China
| | - Dong Li
- Department of Cardiovascular Surgery, The First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing, 100853, China
| | - Nan Cheng
- Department of Cardiovascular Surgery, The First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing, 100853, China
| | - Lianggang Li
- Department of Cardiovascular Surgery, The First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing, 100853, China
| | - Shiyong Dong
- Department of Cardiovascular Surgery, The First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing, 100853, China
| | - Hong Shen
- Department of Cardiovascular Surgery, The First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing, 100853, China
| | - Lin Zhang
- Department of Cardiovascular Surgery, The First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing, 100853, China.
| | - Shengli Jiang
- Department of Cardiovascular Surgery, The First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing, 100853, China.
| |
Collapse
|
2
|
Tan T, Wei P, Liu Y, Huang H, Zhuang J, Chen J, Liu J, Guo H. Safety and efficacy of two-port thoracoscopic aortic valve replacement. J Cardiothorac Surg 2023; 18:9. [PMID: 36611206 PMCID: PMC9824918 DOI: 10.1186/s13019-022-02086-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 12/11/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Pure aortic valve disease is common and has been treated with sternotomy aortic valve replacement for decades. Minimally invasive cardiac surgery has been widely used in atrioventricular valve lesions, but totally thoracoscopic aortic valve replacement has rarely been reported. METHOD The profiles of 9 patients who were diagnosed with severe aortic valve diseases and treated with two-port thoracoscopic aortic valve replacement between February 2021 and February 2022 were retrospectively reviewed. The clinical data, including baseline characteristics, operative data, postoperative complications, and short-term outcomes, were reported. RESULTS All nine patients successfully underwent two-port thoracoscopic aortic valve replacement, with a cardiopulmonary bypass time of 137.56 ± 27.99 min and an aortic cross-clamp time of 95.33 ± 17.96 min. Seven (77.78%) patients underwent mechanical valve replacement, and two (22.22%) patients underwent bioprosthetic valve replacement. Two (22.22%) patients underwent a concomitant aortic root enlargement procedure. There were no intraoperative or postoperative deaths. The incidence of procedural complications was 0%, while the results of ventilation time, intensive care unit stay length, blood transfusion, chest tube drainage, and kidney function were satisfactory. CONCLUSION Two-port thoracoscopic aortic valve replacement is a safe and effective surgical treatment option for carefully selected patients with pure aortic valve diseases.
Collapse
Affiliation(s)
- Tong Tan
- Shantou University Medical College, Shantou, China
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, China
| | - Peijian Wei
- Department of Structure Heart Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yanjun Liu
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, China
| | - Huanlei Huang
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, China
| | - Jian Zhuang
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, China
| | - Jimei Chen
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, China
| | - Jian Liu
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
- Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, China.
| | - Huiming Guo
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
- Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, China.
| |
Collapse
|
3
|
Liu J, Wei P, Liu Y, Ma J, Wu H, Tan T, Chen Z, Chen J, Huang H, Guo H. Trends in redo mitral procedure for treating mitral bioprostheses failure: a single center's experience. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1306. [PMID: 34532443 PMCID: PMC8422140 DOI: 10.21037/atm-21-3118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/07/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Transcatheter mitral valve-in-valve implantation (TM-VIV) has emerged as a viable and attractive alternative to surgical mitral valve replacement (SMVR). This study aimed to review a single-center experience with redo mitral procedure for mitral bioprostheses failure over an 8-year period. In addition, it compared procedural safety and early outcomes of various approaches. METHODS Between January 2013 and January 2021, 79 consecutive patients who underwent redo procedure for mitral bioprostheses failure in our institution were retrospectively reviewed. SMVR and transapical TM-VIV were performed in 54 and 25 patients, respectively. In the SMVR group, 12 patients underwent totally thoracoscopic redo mitral valve replacement (MVR). RESULTS The annual volume of procedures grew continuously during the study period, with the use of totally thoracoscopic redo MVR increasing from 0% in 2012 to 20% in 2019. In 2020, 84.2% of total procedures were performed via the transcatheter approach. Patients in the TM-VIV group were significantly older and had higher scores on the European System for Cardiac Operative Risk Evaluation II (EuroScore II) and the Society of Thoracic Surgeons Predicted Risk of Mortality (STS PROM) (P<0.01). The in-hospital mortality for the SMVR group and TM-VIV group was 3.7% (2 patients) and 0, respectively. Compared to the SMVR group, TM-VIV was associated with shorter ventilation time, intensive care unit stay, and postoperative in-hospital stay, and there was less need for blood transfusion. In the subgroup analysis, no significant difference was detected among most perioperative outcomes between the totally thoracoscopy approach group and the TM-VIV group. CONCLUSIONS There is an increasing number of patients demanding surgical treatments for mitral bioprostheses failure. TM-VIV is playing a significant role due to its scope of application and excellent outcomes.
Collapse
Affiliation(s)
- Jian Liu
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
| | - Peijian Wei
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Yanjun Liu
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
| | - Jiexu Ma
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Hongxiang Wu
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
| | - Tong Tan
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Zhao Chen
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
| | - Jimei Chen
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
| | - Huanlei Huang
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
| | - Huiming Guo
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
| |
Collapse
|