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Three ports thoracoscopic techniques for Redo-MVR without thoracotomy: A short-term clinical observation on safety and feasibility
zengshan ma, Sr., hourong sun.
Shandong Unversity, Ji'nan, China.

OBJECTIVE: To investigate the feasibility and safety of tatolly thoracoscopic Redo- MVR through three right chest incision without thoracotomy.
METHODS: The Redo- MVR through right chest incision under totally thoracoscopy was performed in 32 patients (19 males; mean age 56.8±7.1 years) without thoracotomy in the observer group. An additional 36 patients undergoing conventional median thoracotomy Redo- MVR were selected as a control group. All patients in the observer group were mitral valve and prosthetic valve dysfunction after MVR, repair of mitral valve and for from 2 years to 19 years. Under totally thoracoscopic,pericardial adhesions right atrial incision at the same time and atrial septal was opened in longitudinal axis of fossa ovalis, three stay sutures were placed on the incision to expose the left atrial structure and mitral valve. Cooling to ventricular fibrillation and Carbon dioxide gas filling intrathoracic. The mitral valves were ablated and Prosthesis was placed on home position. After mitral valve replacement, the atrial septal and right atrium or the incision of interatrial groove was closed.
RESULTS: All patients did not die,The operation time and cardiopulmonary bypass times were 188.5±33.6, 68.1±16.7 and 381.1±48.5, 89.7±19.8 min between observer group and control group, respectively. There was no mortalities. The intensive care unit (24.9±12.1 vs 41.9 ± 15.3 hours, P <0.01) or postoperative hospital stays (8.7±2.8 vs 11.4± 2.5 days, P <0.05) in the observer group were shorter than in the control group. Rate of blood transfusion during the operation in the thoracoscopic group was also lower than in the control group (21.6% vs 100%, P =0.001). The volume of drainage was 115 ±22 ml, 892±221 ml. Transesophageal echocardiographic analysis 6.3 ± 3.4 months after the operation showed improved heart function and normal prosthesis.
CONCLUSIONS: Three ports thoracoscopic techniques for Redo-MVR without thoracotomy is safe and effective.

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