Efficacy of aortic valve replacement through the right third intercostal small incision versus median sternal incision: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YAN Lei ¹ , CHEN Qingwei ¹ , CHEN Guoqing ¹ , GAO Yang ² ,  QIAO Yanli ¹

1. Department of Cardiovascular Surgery, Affiliated Hospital of Jining Medical College, Jining, 272029, Shandong, P. R. China;
2. Department of Cardiac Intensive Care Unit, Affiliated Hospital of Jining Medical College, Jining, 272029, Shandong, P. R. China;

Corresponding author：

QIAO Yanli, Email: yanliq802@aliyun.com

Keywords：

Aortic valve replacement; right third intercostal small incision; median sternal incision; peripheral cardiopulmonary bypass

DOI：

10.7507/1007-4848.202101104

Video：

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Objective To analyze the safety and effectiveness of minimally invasive small incision through the right third intercostal and standard aortic valve replacement.Methods The clinical data of 123 patients with the first simple aortic valve replacement in our hospital from June 2013 to May 2020 were retrospectively analyzed. The patients receiving aortic valve replacement through the right third intercostal small incision were allocated to a minimally invasive group, and patients receiving aortic valve replacement through the median sternal incision were allocated to a common group. The clinical outcomes of the two groups were compared.Results There were 40 patients in the minimally invasive group, including 11 (27.5%) females and 29 (72.5%) males, aged 54.60±9.98 years with the body mass index (BMI) of 23.16±2.48 kg/m². There were 83 patients in the common group, including 27 (32.5%) females, 56 (67.5%) males, aged 58.77±9.71 years, with the BMI of 24.13±3.13 kg/m². Compared with the common group, the aortic cross-clamping time, cardiopulmonary bypass time, and operation time were longer (P<0.05), the ventilator support time was shorter (P<0.05), and the blood loss, postoperative 24 h chest drainage volume and total expense were less (P<0.05) in the minimally invasive group. The ICU stay, postoperative hospital stay, and total hospital stay were not statistically different between the two groups (P>0.05).Conclusion The aortic valve replacement through the right third intercostal small incision is safe and effective, with less blood loss, 24 h chest drainage volume and invasiveness.

Citation： YAN Lei, CHEN Qingwei, CHEN Guoqing, GAO Yang, QIAO Yanli. Efficacy of aortic valve replacement through the right third intercostal small incision versus median sternal incision: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(4): 540-545. doi: 10.7507/1007-4848.202101104 Copy

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2.	易定华, 俞世强, 徐学增, 等. 我国胸腔镜微创心脏手术技术操作规范专家共识(征求意见稿第二版). 中国胸心血管外科临床杂志, 2016, 23(4): 315-318.
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4.	董念国, 胡行健. 微创心脏外科发展现状及思考. 临床心血管病杂志, 2015, 31(4): 362-366.
5.	朱家全, 鲍春荣, 张俊文, 等. 右胸前外侧小切口微创主动脉瓣置换的倾向评分匹配研究. 中国心血管病研究, 2018, 16(4): 353-357.
6.	贺清, 金屏, 俞世强, 等. 完全胸腔镜技术在中国心脏外科领域的发展现状. 中国胸心血管外科临床杂志, 2017, 24(1): 65-68.
7.	Balkhy HH, Kitahara H. First human totally endoscopic robotic-assisted sutureless aortic valve replacement. Ann Thorac Surg, 2020, 109(1): e9-e11.
8.	Durko AP, Osnabrugge RL, Kappetein AP. Long-term outlook for transcatheter aortic valve replacement. Trends Cardiovasc Med, 2018, 28(3): 174-183.
9.	Wiedemann D, Laufer G, Coti I, et al. Anterior right thoracotomy for rapid deployment aortic valve replacement. Ann Thorac Surg, 2020: S0003-4975(20)31823-3.
10.	倪良春, 乔衍礼, 陈国庆, 等. 右胸前第 3 肋间小切口心脏瓣膜手术 129 例. 中国胸心血管外科临床杂志, 2016, 23(5): 515-517.
11.	姜兆磊, 梅举, 丁芳宝, 等. 微创右胸切口与常规胸骨正中切口主动脉瓣置换术的对比研究. 中国胸心血管外科临床杂志, 2014, 21(6): 762-765.
12.	Seitz M, Goldblatt J, Paul E, et al. Minimally invasive aortic valve replacement via right anterior mini-thoracotomy: Propensity matched initial experience. Heart Lung Circ, 2019, 28(2): 320-326.
13.	Chang C, Raza S, Altarabsheh SE, et al. Minimally invasive approaches to surgical aortic valve replacement: A meta-analysis. Ann Thorac Surg, 2018, 106(6): 1881-1889.
14.	Santarpino G, Berretta P, Kappert U, et al. Minimally invasive redo aortic valve replacement: Results from a multicentric registry (SURD-IR). Ann Thorac Surg, 2020, 110(2): 553-557.
15.	张永会, 张林, 李梁钢, 等. 微创切口与胸骨正中切口主动脉瓣置换术中倾向性评分匹配的对比研究. 中国心血管病研究, 2019, 17(12): 1079-1083.
16.	Paparella D, Malvindi PG, Santarpino G, et al. Full sternotomy and minimal access approaches for surgical aortic valve replacement: A multicentre propensity-matched study. Eur J Cardiothorac Surg, 2020, 57(4): 709-716.
17.	高阳, 乔衍礼, 陈庆伟, 等. 经右侧胸骨旁第 3 肋间小切口与传统正中开胸行二尖瓣置换的对比研究. 中国胸心血管外科临床杂志, 2019, 26(12): 1204-1207.
18.	凌云鹏, 鲍黎明, 杨威, 等. 左胸小切口非体外循环冠状动脉旁路移植术 70 例. 中国胸心血管外科临床杂志, 2015, 22(6): 550-553.
19.	程才, 魏翔. 系统化、精准化、个体化的微创心脏外科体系. 临床外科杂志, 2017, 25(5): 343-345.
20.	Elattar MA, van Kesteren F, Wiegerinck EM, et al. Automated CTA based measurements for planning support of minimally invasive aortic valve replacement surgery. Med Eng Phys, 2017, 39: 123-128.
21.	Klein P, Klop IDG, Kloppenburg GLT, et al. Planning for minimally invasive aortic valve replacement: Key steps for patient assessment. Eur J Cardiothorac Surg, 2018, 53(suppl_2): ii3-ii8.
22.	Glauber M, Ferrarini M, Miceli A. Minimally invasive aortic valve surgery: State of the art and future directions. Ann Cardiothorac Surg, 2015, 4(1): 26-32.
23.	Stoliński J, Plicner D, Grudzień G, et al. Computed tomography helps to plan minimally invasive aortic valve replacement operations. Ann Thorac Surg, 2016, 101(5): 1745-1752.
24.	Fabre O, Durand F, Hysi I. A novel computed tomography scan tool for patient selection in minithoracotomy aortic replacement. Ann Thorac Surg, 2020, 110(4): e339-e341.
25.	Elattar MA, Kaya A, Planken NR, et al. A computed tomography-based planning tool for predicting difficulty of minimally invasive aortic valve replacement. Interact Cardiovasc Thorac Surg, 2018, 27(4): 505-511.
26.	Jahangiri M, Hussain A, Akowuah E. Minimally invasive surgical aortic valve replacement. Heart, 2019, 105(Suppl 2): s10-s15.
27.	Ramchandani MK, Wyler von Ballmoos MC, Reardon MJ. Minimally invasive surgical aortic valve replacement through a right anterior thoracotomy: How I teach it. Ann Thorac Surg, 2019, 107(1): 19-23.
28.	Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2017, 38(36): 2739-2791.
29.	Writing Committee Members, Otto CM, Nishimura RA, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol, 2021, 77(4): e25-e197.
30.	Mikus E, Turci S, Calvi S, et al. Aortic valve replacement through right minithoracotomy: Is it really biologically minimally invasive? Ann Thorac Surg, 2015, 99(3): 826-830.
31.	Bouchot O, Petrosyan A, Morgant MC, et al. Technical points for aortic valve replacement through right anterior minithoracotomy. Eur J Cardiothorac Surg, 2018, 53(suppl_2): ii24-ii26.

1. Rao PN, Kumar AS. Aortic valve replacement through right thoracotomy. Tex Heart Inst J, 1993, 20(4): 307-308.
2. 易定华, 俞世强, 徐学增, 等. 我国胸腔镜微创心脏手术技术操作规范专家共识(征求意见稿第二版). 中国胸心血管外科临床杂志, 2016, 23(4): 315-318.
3. 卢锋, 徐建军. 微创主动脉瓣置换术的现状及展望. 中国心血管病研究, 2020, 18(9): 836-839.
4. 董念国, 胡行健. 微创心脏外科发展现状及思考. 临床心血管病杂志, 2015, 31(4): 362-366.
5. 朱家全, 鲍春荣, 张俊文, 等. 右胸前外侧小切口微创主动脉瓣置换的倾向评分匹配研究. 中国心血管病研究, 2018, 16(4): 353-357.
6. 贺清, 金屏, 俞世强, 等. 完全胸腔镜技术在中国心脏外科领域的发展现状. 中国胸心血管外科临床杂志, 2017, 24(1): 65-68.
7. Balkhy HH, Kitahara H. First human totally endoscopic robotic-assisted sutureless aortic valve replacement. Ann Thorac Surg, 2020, 109(1): e9-e11.
8. Durko AP, Osnabrugge RL, Kappetein AP. Long-term outlook for transcatheter aortic valve replacement. Trends Cardiovasc Med, 2018, 28(3): 174-183.
9. Wiedemann D, Laufer G, Coti I, et al. Anterior right thoracotomy for rapid deployment aortic valve replacement. Ann Thorac Surg, 2020: S0003-4975(20)31823-3.
10. 倪良春, 乔衍礼, 陈国庆, 等. 右胸前第 3 肋间小切口心脏瓣膜手术 129 例. 中国胸心血管外科临床杂志, 2016, 23(5): 515-517.
11. 姜兆磊, 梅举, 丁芳宝, 等. 微创右胸切口与常规胸骨正中切口主动脉瓣置换术的对比研究. 中国胸心血管外科临床杂志, 2014, 21(6): 762-765.
12. Seitz M, Goldblatt J, Paul E, et al. Minimally invasive aortic valve replacement via right anterior mini-thoracotomy: Propensity matched initial experience. Heart Lung Circ, 2019, 28(2): 320-326.
13. Chang C, Raza S, Altarabsheh SE, et al. Minimally invasive approaches to surgical aortic valve replacement: A meta-analysis. Ann Thorac Surg, 2018, 106(6): 1881-1889.
14. Santarpino G, Berretta P, Kappert U, et al. Minimally invasive redo aortic valve replacement: Results from a multicentric registry (SURD-IR). Ann Thorac Surg, 2020, 110(2): 553-557.
15. 张永会, 张林, 李梁钢, 等. 微创切口与胸骨正中切口主动脉瓣置换术中倾向性评分匹配的对比研究. 中国心血管病研究, 2019, 17(12): 1079-1083.
16. Paparella D, Malvindi PG, Santarpino G, et al. Full sternotomy and minimal access approaches for surgical aortic valve replacement: A multicentre propensity-matched study. Eur J Cardiothorac Surg, 2020, 57(4): 709-716.
17. 高阳, 乔衍礼, 陈庆伟, 等. 经右侧胸骨旁第 3 肋间小切口与传统正中开胸行二尖瓣置换的对比研究. 中国胸心血管外科临床杂志, 2019, 26(12): 1204-1207.
18. 凌云鹏, 鲍黎明, 杨威, 等. 左胸小切口非体外循环冠状动脉旁路移植术 70 例. 中国胸心血管外科临床杂志, 2015, 22(6): 550-553.
19. 程才, 魏翔. 系统化、精准化、个体化的微创心脏外科体系. 临床外科杂志, 2017, 25(5): 343-345.
20. Elattar MA, van Kesteren F, Wiegerinck EM, et al. Automated CTA based measurements for planning support of minimally invasive aortic valve replacement surgery. Med Eng Phys, 2017, 39: 123-128.
21. Klein P, Klop IDG, Kloppenburg GLT, et al. Planning for minimally invasive aortic valve replacement: Key steps for patient assessment. Eur J Cardiothorac Surg, 2018, 53(suppl_2): ii3-ii8.
22. Glauber M, Ferrarini M, Miceli A. Minimally invasive aortic valve surgery: State of the art and future directions. Ann Cardiothorac Surg, 2015, 4(1): 26-32.
23. Stoliński J, Plicner D, Grudzień G, et al. Computed tomography helps to plan minimally invasive aortic valve replacement operations. Ann Thorac Surg, 2016, 101(5): 1745-1752.
24. Fabre O, Durand F, Hysi I. A novel computed tomography scan tool for patient selection in minithoracotomy aortic replacement. Ann Thorac Surg, 2020, 110(4): e339-e341.
25. Elattar MA, Kaya A, Planken NR, et al. A computed tomography-based planning tool for predicting difficulty of minimally invasive aortic valve replacement. Interact Cardiovasc Thorac Surg, 2018, 27(4): 505-511.
26. Jahangiri M, Hussain A, Akowuah E. Minimally invasive surgical aortic valve replacement. Heart, 2019, 105(Suppl 2): s10-s15.
27. Ramchandani MK, Wyler von Ballmoos MC, Reardon MJ. Minimally invasive surgical aortic valve replacement through a right anterior thoracotomy: How I teach it. Ann Thorac Surg, 2019, 107(1): 19-23.
28. Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2017, 38(36): 2739-2791.
29. Writing Committee Members, Otto CM, Nishimura RA, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol, 2021, 77(4): e25-e197.
30. Mikus E, Turci S, Calvi S, et al. Aortic valve replacement through right minithoracotomy: Is it really biologically minimally invasive? Ann Thorac Surg, 2015, 99(3): 826-830.
31. Bouchot O, Petrosyan A, Morgant MC, et al. Technical points for aortic valve replacement through right anterior minithoracotomy. Eur J Cardiothorac Surg, 2018, 53(suppl_2): ii24-ii26.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Efficacy of aortic valve replacement through the right third intercostal small incision versus median sternal incision: A retrospective cohort study

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