Mat: A Decade Of Innovation And Experience In Mitral Valve Surgery 762 Treated Cases Of Rheumatic Valve Disease
zengshan ma, Sr..
Shandong Unversity, Ji'nan, China.
BACKGROUND - Thoracoscopy assisted minimally invasive mitral valve repair (MICS-MVR) through a small right thoracotomy is a novel technique for mitral valve surgery and is increasingly adopted worldwide. This study aims to identify areas of improvement by describing characteristics of MA's tri-port chest thoracoscopic cardiac surgery and mid-term outcomes of a series of MICS MVR. This surgical breakthrough is known as the MA-Technique (MAT) in clinical literature. METHODS - MAT was first pioneered by the author and his research team in 2009. It is a form of totally thoracoscopic heart surgery conducted through three ports on the right chest wall and belongs to the field of microsurgery. The associated procedure is simple and effective, leading to minimal surgical trauma. As of October 2018, MAT has witnessed 2166 cases of successful application. Among them, 762 cases treated for rheumatic mitral valve disease involved patients aged 32-81 years old and weighed from 43-106 kg. Moreover, 697 treated cases consisted of mitral valve replacement and 55 cases for mitral valvuloplasty. An additional 36 control patients were recruited to undergo open-chest MVR. Patient information is collected for further statistical analysis. The data processed includes but is not limited to preoperative cardiac information, operation time, CPB time, cardiac arrest time, ICU stay duration, ventilator-support time, hospitalization period, postoperative drainage volume, blood transfusion rate, incidence of morbidity, rate of mortality, and post-surgery assessment. RESULTS - Post-surgery information points to a 14.3% blood transfusion rate and a postoperative ventilator-support time ranging from 3.1-29.4hr (with a mean and deviation of 5.1 ± 0.8 hr). Similarly, pleural fluid drainage ranged between 45-650 ml (95 ± 26 ml). The research team tabulated a 19hr average ICU stay length with a range of 3-56 hr. An average 6.1-day post-surgery hospitalization time that ranged between 4-14 days for all 762 treated cases of rheumatic mitral valve disease was also computed. It is pertinent to note that there were 2 cases of death, 2 cases that required conventional open surgery, 9 cases of pulmonary infection postoperative, and 12 cases of secondary hemostasis. The team tracked 750 cases for 1-94 months in a subsequent follow-up. This group of patients had 3 cases of death in post-hospital discharge, and 2 cases of death resulting from cardiac causes. Compared to the control group, MAT significantly reduces the time associated with surgical operation, CPB, cardioplegia, ICU length of stay, ventilator-support, and hospitalization. Additionally, MAT has smaller odds of complication and postoperative drainage while lowering the rates of blood transfusion and use of pain medication. CONCLUSIONS - Through repeated surgical amendments, MAT has evolved to deliver clinical excellence and is more advantageous than conventional surgery. It overcomes the drawbacks of small-incision-based cardiac surgery in terms of field of vision, procedural challenges, surgical trauma, and post-surgical pain in tandem to circumventing the shortcomings of robotically-assisted heart surgery.
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