Clinical efficacy and survival analysis of totally thoracoscopic redo mitral valve replacement_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WEI Peijian ^1,2 , LIU Jian ¹ , MA Jiexu ^1,2 , CHEN Zhao ¹ , ZHANG Yuyuan ^1,3 , TAN Tong ^1,2 , LIU Yanjun ¹ , WU Hongxiang ¹ , HUANG Huanlei ¹ , CHEN Jimei ¹ , ZHUANG Jian ¹ ,  GUO Huiming ¹

1. Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, P. R. China;
2. Shantou University Medical College, Shantou, 515041, Guangdong, P. R. China;
3. Department of Cardiovascular Surgery, Guangdong General Hospital’s Nanhai Hospital, The Second People’s Hospital of Nanhai District, Foshan, 528251, Guangdong, P. R. China;

Corresponding author：

GUO Huiming, Email: guohuiming@gdph.org.cn

Keywords：

Redo mitral valve replacement; totally thoracoscopic; cardiopulmonary bypass; survival analysis

DOI：

10.7507/1007-4848.202104012

Video：

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Objective To analyze the clinical efficacy and survival outcome of totally thoracoscopic redo mitral valve replacement and evaluate its efficiency and safety. Methods The clinical data of patients with totally thoracoscopic redo mitral valve replacement in Guangdong Provincial People’s Hospital between 2013 and 2019 were retrospectively analyzed. Survival analysis was performed using the Kaplan-Meier method. Univariate and multivariate Cox regression analyses were used to determine the risk factors for postoperative death. Results There were 48 patients including 29 females and 19 males with a median age of 53 (44, 66) years. All the procedures were performed successfully with no conversion to median sternotomy. A total of 15, 10 and 23 patients received surgeries under non-beating heart, beating heart and ventricular fibrillation, respectively. The in-hospital mortality rate was 6.25% (3/48), and the incidence of early postoperative complications was 18.75% (9/48). Thirty-five (72.92%) patients had their tracheal intubation removed within 24 hours after the operation. The 1- and 6-year survival rates were 89.50% (95%CI 81.30%-98.70%) and 82.90% (95%CI 71.50%-96.20%), respectively. Age>65 years was an independent risk factor for postoperative death (P=0.04). Conclusion Totally thoracoscopic redo mitral valve replacement is safe and reliable, with advantages of rapid recovery, reducing blood transfusion rate, reducing postoperative complications and acceptable long-term survival rate. It is worthy of being widely popularized in the clinic.

Citation： WEI Peijian, LIU Jian, MA Jiexu, CHEN Zhao, ZHANG Yuyuan, TAN Tong, LIU Yanjun, WU Hongxiang, HUANG Huanlei, CHEN Jimei, ZHUANG Jian, GUO Huiming. Clinical efficacy and survival analysis of totally thoracoscopic redo mitral valve replacement. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(5): 731-737. doi: 10.7507/1007-4848.202104012 Copy

1.	Mehaffey HJ, Hawkins RB, Schubert S, et al. Contemporary outcomes in reoperative mitral valve surgery. Heart, 2018, 104(8): 652-656.
2.	Cohn LH. Evolution of redo cardiac surgery: Review of personal experience. J Card Surg, 2004, 19(4): 320-324.
3.	Grossi EA, Loulmet DF, Schwartz CF, et al. Evolution of operative techniques and perfusion strategies for minimally invasive mitral valve repair. J Thorac Cardiovasc Surg, 2012, 143(4Suppl): S68-S70.
4.	Grant SW, Hickey GL, Modi P, et al. Propensity-matched analysis of minimally invasive approach versus sternotomy for mitral valve surgery. Heart, 2019, 105(10): 783-789.
5.	Liu J, Chen B, Zhang YY, et al. Mitral valve replacement via minimally invasive totally thoracoscopic surgery versus traditional median sternotomy: A propensity score matched comparative study. Ann Transl Med, 2019, 7(14): 341.
6.	Cao H, Zhou Q, Fan F, et al. Right anterolateral thoracotomy: An attractive alternative to repeat sternotomy for high-risk patients undergoing reoperative mitral and tricuspid valve surgery. J Cardiothorac Surg, 2017, 12(1): 85.
7.	Cao H, Zhou Q, Xue Y, et al. Mitral valve surgery via a right infra-axillary thoracotomy in high-risk reoperative patients. Heart Surg Forum, 2020, 23(2): E200-E204.
8.	Monsefi N, Öztürk M, Shavahatli T, et al. Right mini-thoracotomy approach in patients undergoing redo mitral valve procedure. Indian J Thorac Cardiovasc Surg, 2020, 36(6): 591-597.
9.	曹海龙, 周庆, 王东进. 右侧乳缘下切口在再次瓣膜手术中的应用. 中国胸心血管外科临床杂志, 2018, 25(3): 262-264.
10.	蒋辉, 葛建军, 赵智伟. 胸腔镜辅助心脏不停跳下微创再次二尖瓣手术的临床研究. 重庆医学, 2014, 43(25): 3339-3340.
11.	李少珂, 刘博, 左龙, 等. 3D 胸腔镜在再次二尖瓣/三尖瓣手术中的应用. 中国心血管病研究, 2021, 19(1): 11-15.
12.	Seeburger J, Borger MA, Falk V, et al. Minimally invasive mitral valve surgery after previous sternotomy: Experience in 181 patients. Ann Thorac Surg, 2009, 87(3): 709-714.
13.	Modi P, Hassan A, Chitwood WR. Minimally invasive mitral valve surgery: A systematic review and meta-analysis. Eur J Cardiothorac Surg, 2008, 34(5): 943-952.
14.	Gammie JS, Zhao Y, Peterson ED, et al. J. Maxwell Chamberlain Memorial Paper for adult cardiac surgery. Less-invasive mitral valve operations: Trends and outcomes from the Society of Thoracic Surgeons Adult Cardiac Surgery Database. Ann Thorac Surg, 2010, 90(5): 1401-1408.
15.	Lange R, Voss B, Kehl V, et al. Right minithoracotomy versus full sternotomy for mitral valve repair: A propensity matched comparison. Ann Thorac Surg, 2017, 103(2): 573-579.
16.	魏来, 陈楠, 杨晔, 等. 2019 年度中国微创心血管外科手术统计. 中国胸心血管外科临床杂志, 2021, 28(2): 149-153.
17.	Daemen JHT, Heuts S, Olsthoorn JR, et al. Right minithoracotomy versus median sternotomy for reoperative mitral valve surgery: A systematic review and meta-analysis of observational studies. Eur J Cardiothorac Surg, 2018, 54(5): 817-825.
18.	龙翔, 吴永兵, 朱书强, 等. 胸腔镜辅助右侧小切口在二次心脏瓣膜手术中的应用. 中国老年学杂志, 2017, 37(14): 3547-3548.
19.	杨兆华, 杨守国, 陈昊, 等. 右胸前外侧小切口在再次二尖瓣手术中的应用及疗效分析. 中华胸心血管外科杂志, 2014, 30(11): 674-676.
20.	何维来, 李鑫, 车轰, 等. 再次心脏房室瓣手术的微创化探索. 中国胸心血管外科临床杂志, 2022, 29(6): 755-760.
21.	Dobell AR, Jain AK. Catastrophic hemorrhage during redo sternotomy. Ann Thorac Surg, 1984, 37(4): 273-278.
22.	Loop FD. Catastrophic hemorrhage during sternal reentry. Ann Thorac Surg, 1984, 37(4): 271-272.
23.	Losenno KL, Jones PM, Valdis M, et al. Higher-risk mitral valve operations after previous sternotomy: Endoscopic, minimally invasive approach improves patient outcomes. Can J Surg, 2016, 59(6): 399-406.
24.	Kitamura T, Stuklis RG, Edwards J. Redo mitral valve operation via right minithoracotomy—"no touch" technique. Int Heart J, 2011, 52(2): 107-109.
25.	Romano MA, Haft JW, Pagani FD, et al. Beating heart surgery via right thoracotomy for reoperative mitral valve surgery: A safe and effective operative alternative. J Thorac Cardiovasc Surg, 2012, 144(2): 334-339.
26.	Hiraoka A, Kuinose M, Totsugawa T, et al. Mitral valve reoperation under ventricular fibrillation through right mini-thoracotomy using three-dimensional videoscope. J Cardiothorac Surg, 2013, 8: 81.
27.	钟执文, 雷迁, 张晓慎, 等. 胸腔镜再次心脏瓣膜手术的体外循环管理. 实用医院临床杂志, 2016, 13(1): 16-19.
28.	Ad N, Holmes SD, Shuman DJ, et al. Minimally invasive mitral valve surgery without aortic cross-clamping and with femoral cannulation is not associated with increased risk of stroke compared with traditional mitral valve surgery: A propensity score-matched analysis. Eur J Cardiothorac Surg, 2015, 48(6): 868-872.

1. Mehaffey HJ, Hawkins RB, Schubert S, et al. Contemporary outcomes in reoperative mitral valve surgery. Heart, 2018, 104(8): 652-656.
2. Cohn LH. Evolution of redo cardiac surgery: Review of personal experience. J Card Surg, 2004, 19(4): 320-324.
3. Grossi EA, Loulmet DF, Schwartz CF, et al. Evolution of operative techniques and perfusion strategies for minimally invasive mitral valve repair. J Thorac Cardiovasc Surg, 2012, 143(4Suppl): S68-S70.
4. Grant SW, Hickey GL, Modi P, et al. Propensity-matched analysis of minimally invasive approach versus sternotomy for mitral valve surgery. Heart, 2019, 105(10): 783-789.
5. Liu J, Chen B, Zhang YY, et al. Mitral valve replacement via minimally invasive totally thoracoscopic surgery versus traditional median sternotomy: A propensity score matched comparative study. Ann Transl Med, 2019, 7(14): 341.
6. Cao H, Zhou Q, Fan F, et al. Right anterolateral thoracotomy: An attractive alternative to repeat sternotomy for high-risk patients undergoing reoperative mitral and tricuspid valve surgery. J Cardiothorac Surg, 2017, 12(1): 85.
7. Cao H, Zhou Q, Xue Y, et al. Mitral valve surgery via a right infra-axillary thoracotomy in high-risk reoperative patients. Heart Surg Forum, 2020, 23(2): E200-E204.
8. Monsefi N, Öztürk M, Shavahatli T, et al. Right mini-thoracotomy approach in patients undergoing redo mitral valve procedure. Indian J Thorac Cardiovasc Surg, 2020, 36(6): 591-597.
9. 曹海龙, 周庆, 王东进. 右侧乳缘下切口在再次瓣膜手术中的应用. 中国胸心血管外科临床杂志, 2018, 25(3): 262-264.
10. 蒋辉, 葛建军, 赵智伟. 胸腔镜辅助心脏不停跳下微创再次二尖瓣手术的临床研究. 重庆医学, 2014, 43(25): 3339-3340.
11. 李少珂, 刘博, 左龙, 等. 3D 胸腔镜在再次二尖瓣/三尖瓣手术中的应用. 中国心血管病研究, 2021, 19(1): 11-15.
12. Seeburger J, Borger MA, Falk V, et al. Minimally invasive mitral valve surgery after previous sternotomy: Experience in 181 patients. Ann Thorac Surg, 2009, 87(3): 709-714.
13. Modi P, Hassan A, Chitwood WR. Minimally invasive mitral valve surgery: A systematic review and meta-analysis. Eur J Cardiothorac Surg, 2008, 34(5): 943-952.
14. Gammie JS, Zhao Y, Peterson ED, et al. J. Maxwell Chamberlain Memorial Paper for adult cardiac surgery. Less-invasive mitral valve operations: Trends and outcomes from the Society of Thoracic Surgeons Adult Cardiac Surgery Database. Ann Thorac Surg, 2010, 90(5): 1401-1408.
15. Lange R, Voss B, Kehl V, et al. Right minithoracotomy versus full sternotomy for mitral valve repair: A propensity matched comparison. Ann Thorac Surg, 2017, 103(2): 573-579.
16. 魏来, 陈楠, 杨晔, 等. 2019 年度中国微创心血管外科手术统计. 中国胸心血管外科临床杂志, 2021, 28(2): 149-153.
17. Daemen JHT, Heuts S, Olsthoorn JR, et al. Right minithoracotomy versus median sternotomy for reoperative mitral valve surgery: A systematic review and meta-analysis of observational studies. Eur J Cardiothorac Surg, 2018, 54(5): 817-825.
18. 龙翔, 吴永兵, 朱书强, 等. 胸腔镜辅助右侧小切口在二次心脏瓣膜手术中的应用. 中国老年学杂志, 2017, 37(14): 3547-3548.
19. 杨兆华, 杨守国, 陈昊, 等. 右胸前外侧小切口在再次二尖瓣手术中的应用及疗效分析. 中华胸心血管外科杂志, 2014, 30(11): 674-676.
20. 何维来, 李鑫, 车轰, 等. 再次心脏房室瓣手术的微创化探索. 中国胸心血管外科临床杂志, 2022, 29(6): 755-760.
21. Dobell AR, Jain AK. Catastrophic hemorrhage during redo sternotomy. Ann Thorac Surg, 1984, 37(4): 273-278.
22. Loop FD. Catastrophic hemorrhage during sternal reentry. Ann Thorac Surg, 1984, 37(4): 271-272.
23. Losenno KL, Jones PM, Valdis M, et al. Higher-risk mitral valve operations after previous sternotomy: Endoscopic, minimally invasive approach improves patient outcomes. Can J Surg, 2016, 59(6): 399-406.
24. Kitamura T, Stuklis RG, Edwards J. Redo mitral valve operation via right minithoracotomy—"no touch" technique. Int Heart J, 2011, 52(2): 107-109.
25. Romano MA, Haft JW, Pagani FD, et al. Beating heart surgery via right thoracotomy for reoperative mitral valve surgery: A safe and effective operative alternative. J Thorac Cardiovasc Surg, 2012, 144(2): 334-339.
26. Hiraoka A, Kuinose M, Totsugawa T, et al. Mitral valve reoperation under ventricular fibrillation through right mini-thoracotomy using three-dimensional videoscope. J Cardiothorac Surg, 2013, 8: 81.
27. 钟执文, 雷迁, 张晓慎, 等. 胸腔镜再次心脏瓣膜手术的体外循环管理. 实用医院临床杂志, 2016, 13(1): 16-19.
28. Ad N, Holmes SD, Shuman DJ, et al. Minimally invasive mitral valve surgery without aortic cross-clamping and with femoral cannulation is not associated with increased risk of stroke compared with traditional mitral valve surgery: A propensity score-matched analysis. Eur J Cardiothorac Surg, 2015, 48(6): 868-872.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical efficacy and survival analysis of totally thoracoscopic redo mitral valve replacement

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