Comparison of long-term results of mitral valvuloplasty with minimally invasive and median sternotomy approach for rheumatic mitral valve disease

MP010 

Abstract Submission 

Huanlei Huang (1), Zhenzhong Wang (1), Junfei Zhao (2)

(1) N/A, N/A, (2) Guangdong Provincial People's Hospital, Guangzhou, Guangdong

Huanlei Huang    -  Contact Me
N/A

Zhenzhong Wang    -  Contact Me
N/A

Junfei Zhao    -  Contact Me
Guangdong Provincial People's Hospital

Huanlei Huang    -  Contact Me
N/A

Objective: It is unknown whether video aided thoracoscopic mitral valve repair(VATS-MVP) in patients with Rheumatic heart disease(RHD) differs from conventional median sternotomy(MS) approach in terms of preoperative patient selection, intraoperative surgical strategy, perioperative results, and long-term prognosis. The aim of this study was to examine the safety, efficacy and durability of VATS-MVP in RHD.
Methods: A retrospective collection with clinical data, echocardiography results, and follow-up data was used to identify 235 consecutive patients underwent MVP for RHD from January 2007 through June 2022, including 114 patients via MS approach and 121 patients via VATS approach(Table 1). A comparison between the MS group and the VATS group was conducted.
Results: One patient death in hospital was observed in the VATS group. Follow-up was 96.1% complete (range, 0.15-14.8 years). There was a higher percentage of artificial ring implantation in the VATS group, but there was no difference between the two groups(P=0.246). Although the total operation time (227.9±72.8 vs 235.2±63.3 min, P=0.155) between the two groups was not statistical different, the VATS group had longer cardiopulmonary bypass time(159.9±46.3 vs 134.9±48.3min, P=0.000) and aortic clamp time(102.9±32.6 vs. 87.5±34.5 min, P=0.001) . The incidence of lung infection and poor wound healing was high in MS group(P<0.05). Pleural effusion is common in VATS group(P<0.05). No significant difference between the two groups in other adverse perioperative complications(P>0.05). Mechanical ventilation time (P=0.015), ICU time(P=0.153), and postoperative hospitalization time(P=0.230) were all shorter in the VATS group. Two patients in the MS group died during the follow-up period. The 1-year, 5-year and 10-year survival rates of VATS groups were all 99.2%. At 1-year, 5-year, 10-year in the AVTS group, the rate of freedom from moderate or greater(>=2+) mitral regurgitation were 87.6%, 74.3%,and 74.3%, respectively. Compared with MS group, there was no significant difference in the survival rate, recurrence rate of mitral regurgitation, reoperation rate and incidence rate of adverse cardiovascular and cerebrovascular events in VATS group(P＞0.05).
Conclusions: Rheumatic mitral valve disease could be effectively and safely repaired with excellent long-term durability via totally endoscopic minimally invasive approach in selected patients.

Rheumatic Mitral Valve Disease