[Minimally invasive aortic valve replacement for isolated aortic valve disease: clinical analysis of 101 consecutive patients].

OBJECTIVE: To review the results for minimally invasive aortic valve replacement (AVR) through a 5 cm right anterolateral thoracotomy. METHODS: From July 2009 to September 2011, 101 consecutive patients with isolated aortic valve disease (degenerative in 37 patients, rheumatic in 21 patients, congenital in 37 patients, endocarditic in 3 patients and aorta-arteritis in 1 patients) underwent AVR through the right anterolateral thoracotomy approach in the third intercostal space with a groin incision for femoral connection of cardiopulmonary bypass. The mean age was 45.7 years (ranging from 17 to 71 years). Sixty patients were male. RESULTS: Operations were successfully performed in all but 1 patient (1.0%) who required intraoperative conversion to full sternotomy. Mean duration of cardiopulmonary bypass time and aortic cross-clamp time was (88 ± 24) minutes and (55 ± 18) minutes, respectively. Thirty-day mortality was 1.0% (1/101), this patient was found difficult in weaning off cardiopulmonary bypass and exhibited severe coronary artery plaque, although bypass graft was carried out immediately, the patient died of severe low cardiac output syndrome finally. No blood products were needed in 83.2% patients. Follow-up was performed in all patients at an average of (16 ± 7) months postoperatively. A good recovery was obtained in all patients except one who died of multiple organ failure caused by massive cerebral infarction 38 days after surgery. CONCLUSIONS: Minimally invasive aortic valve replacement though the right anterolateral thoracotomy approach is safe and feasible, with good cosmetic results and rapid postoperative recovery. It is worthy of clinical elective application.

[Repair of posterior mitral valve prolapsed: comparative study of three different approaches].

OBJECTIVE: To compared outcomes of robotic mitral valve repair with those of standard sternotomy, and right anterolateral thoracotomy. METHOD: From August 2010 to July 2011, 70 patients with degenerative mitral valve disease and posterior leaflet prolapsed scheduled for elective isolated mitral valve repair were prospectively nonrandomized to undergo mitral valve operation by standard sternotomy (n = 30), right anterolateral thoracotomy (n = 30), or a robotic approach (n = 10). There were 49 male and 21 female patients, aging from 16 to 70 years with a mean of 53.4 years. Outcomes of the three groups were compared. RESULTS: Mitral valve repair was achieved in all patients except 1 patient in the standard group. There were no in-hospital deaths. The median operation time [(300 ± 41) min, (184 ± 20) min and (169 ± 22) min, F = 112.5, P < 0.01], cardiopulmonary bypass time [(139 ± 26) min, (82 ± 20) min and (69 ± 23) min, F = 36.8, P < 0.01], aortic cross-clamping time [(93 ± 23) min, (47 ± 10) min and (38 ± 8) min, F = 75.0, P < 0.01] were longer for robotic than standard sternotomy and right anterolateral thoracotomy. The robotic group had shortest time of mechanical ventilation time [(4.9 ± 2.1) h, (5.3 ± 4.5) h and (14.1 ± 10.2) h, F = 13.2, P < 0.01], ICU time [(15.1 ± 2.1) h, (16.4 ± 5.4) h and (28.7 ± 16.1) h, F = 11.6, P < 0.01], postoperative hospital stay time [(4.6 ± 1.0) d, (5.7 ± 1.7) d and (8.8 ± 5.1) d, F = 8.0, P < 0.01] with the lowest of drainage [(192 ± 200) ml, (215 ± 163) ml and (405 ± 239) ml, F = 7.1, P < 0.01] and ratio of the patients needed blood transfusion (0, 20.0% and 66.7%, χ(2) = 22.7, P < 0.01). Patients were followed up 6 to 17 months, with 100% completed. No patients died during follow-ups, and no moderate or more mitral regurgitation was observed. The robotic group had the shortest time of return to normal activities compared with the other two groups [(2.4 ± 0.7) weeks, (4.2 ± 1.2) weeks and (8.2 ± 1.8) weeks, F = 83.0, P < 0.01]. CONCLUSION: This study shows mitral valve repair via the right anterolateral thoracotomy and a robotic approach is safe and feasible, with good cosmetic results and rapid postoperative recovery, and is worthy of clinical selective application.

Patients over 70 years of age with moderate ischemic mitral regurgitation undergoing surgical revascularization plus mitral valve repair: insights from a single-center study of propensity-matched data.

BACKGROUND: Elderly patients, compared with the young, have a higher burden of surgical risk factors with reduced functional capacity and increased comorbidities conditions, and may have worse clinical outcomes. So far, few reports have focused on clinical outcomes of patients over 70 years of age with moderate chronic ischemic mitral regurgitation (IMR) undergoing mitral valve repair at the time of coronary artery bypass grafting (CABG). This single-center study of propensity-matched data attempts to answer a question: compared with patients with age of 70 or less, whether patients over 70 years of age with moderate IMR undergoing CABG plus mitral valve repair receive poor outcomes. METHODS: All eligible patients were included in this study and were entered into either an elderly group (n=142) or a control group (n=182) according to patients' age. In-hospital outcomes (consisting of surgical mortality and major postoperative morbidity) and midterm clinical outcomes (including all-cause mortality and recurrent mitral regurgitation) were compared after propensity score matching (1:1). RESULTS: Using propensity-score matching, 103 pairs of patients were successfully established in a 1:1 ratio. No significant differences between the two matched groups were found with regard to surgical mortality (5.8% vs. 3.9%, P=0.754) and major postoperative morbidity. A total of 184 patients (91 in the elderly group and 93 in the control group) received regular follow-up visit with the median duration of 38 months [interquartile range (IQR), 27-56 months]. There were not any significant differences between the two matched groups regarding overall survival and recurrent IMR-free survival (stratified log-rank P=0.185 and stratified log-rank P=0.453, respectively). The elderly group as compared to the control group did not affect midterm mortality via cox proportional hazard regression (propensity score adjusted hazard ratio, 1.143; 95% confidence interval, 0.761-1.943; P=0.285). CONCLUSIONS: Patients over 70 years of age with moderate chronic IMR undergoing combined CABG and mitral valve repair may receive favorable in-hospital and midterm clinical outcomes.

Impact of severe left ventricular dysfunction on in-hospital and mid-term outcomes of Chinese patients undergoing first isolated off-pump coronary artery bypass grafting.

BACKGROUND: Few studies focused on evaluating the impacts of preoperative severe left ventricular dysfunction on clinical outcomes of patients undergoing off-pump coronary artery bypass grafting surgery (OPCAB). This single center retrospective study aimed to evaluate the impacts of severe left ventricular dysfunction on in-hospital and mid-term clinical outcomes of Chinese patients undergoing first, scheduled, and isolated OPCAB surgery. METHODS: From January 2010 to December 2014, 2032 eligible patients were included in this study and were divided into 3 groups: a severe group (patients with preoperative left ventricular ejection fraction (LVEF) of ≤35%, n = 128), an impaired group (patients with preoperative LVEF of 36-50%, n = 680), and a normal group (patients with preoperative LVEF of >50%, n = 1224). In-hospital and follow-up clinical outcomes were investigated and compared. RESULTS: Patients in the severe group compared to the other 2 groups had higher in-hospital mortality and higher incidences of low cardiac output and prolonged ventilation. Kaplan-Meier curves showed a similar cumulative follow-up survival between the severe group and the impaired group (χ2 = 1.980, Log-rank p = 0.159) and between the severe group and the normal group (χ2 = 2.701, Log-rank p = 0.102). Multivariate Cox regression indicated that grouping was not a significant variable related to mid-term all-cause mortality. No significant difference was found in the rate of repeat revascularization between the severe group (2.4%) and the other 2 groups. CONCLUSIONS: Patients with preoperative LVEF of ≤35% compared to preoperative LVEF of >35% increased the risk of in-hospital death and incidences of postoperative low cardiac output and prolonged ventilation, but shared similar mid-term all-cause mortality and repeat revascularization after OPCAB surgery.