ObjectiveTo compare the efficacy and safety of mitral valvuloplasty via minimally invasive approach with those of mitral valvuloplasty via traditional median sternotomy.MethodsA total of 1 221 patients undergoing mitral valvuloplasty from January 2015 to August 2018 in Guangdong Provincial People's Hospital were analyzed retrospectively, including 721 males and 500 females, with an average age of 47.2±15.1 years. According to the different surgical methods, they were divided into a study group (n=654), who received mitral valvuloplasty via the totally thoracoscopic approach, and a control group (n=567), who received mitral valvuloplasty via traditional median sternotomy. Clinical data, surgical results, and perioperative outcomes of the two groups were compared.ResultsThere was no significant difference in preoperative general data between the two groups (P>0.05). Compared with the control group, the study group had longer cardiopulmonary bypass time and aortic cross-clamping time (146.7±42.4 min vs. 122.7±30.6 min, 96.2±32.7 min vs. 78.3±23.8 min, both P=0.000), and shorter total operation time (227.4±55.3 min vs. 238.1±56.4 min, P=0.001). There was no significant difference in the incidence of secondary cross-clamping and mitral valve replacement between the two groups (3.7% vs. 2.6%, P=0.312; 1.7% vs. 1.4%, P=0.690). The blood transfusion rate and the incidence of respiratory tract infection and postoperative poor wound healing were lower (13.0% vs. 24.5%, 2.1% vs. 18.0%, 1.5% vs. 5.3%, all P=0.000) and the postoperative hospital stay was shorter (6.2±4.4 d vs. 11.5±8.8 d, P=0.000) in the study group. There was no significant difference in hospitalization expense between the two groups (95 847.9±31 322.0 yuan vs. 99 673.1±47 930.3 yuan, P=0.149). Within 30 d after surgery, 1 patient died in the study group and 4 patients died in the control group. Before discharge, there were 4 and 5 patients with severe mitral valve regurgitation in the study group and the control group, respectively.ConclusionCompared with mitral valvuloplasty via traditional median sternotomy, minimally invasive mitral valvuloplasty is superior in shortening operation time and postoperative hospital stay, lowering blood transfusion rate, and reducing postoperative complications, which can achieve better clinical outcomes.
Objective To evaluate the perioperative management strategies and clinical outcomes in a cohort of 22 patients with end-stage heart failure undergoing implantation of left ventricular assist device (LVAD). Methods A retrospective analysis was conducted on the clinical records of patients with end-stage heart failure treated with LVAD at West China Hospital of Sichuan University between January 2021 and June 2025. Surgical outcomes were assessed using perioperative variables, including operative duration, cardiopulmonary bypass and aortic cross-clamp time, length of ICU stay, incidence of adverse events, as well as cardiac function and hemodynamic status at the time of discharge. ResultsThe study included 22 patients (19 male, 3 female) with a mean age of (47.9±12.6) years (range: 27-67 years). Preoperatively, all patients were classified as New York Heart Association (NYHA) functional class Ⅳ. All implantations were performed successfully; however, there were two perioperative mortalities due to gastrointestinal bleeding. Post-implantation, significant improvements in cardiac function and hemodynamics were observed: left ventricular ejection fraction increased from a baseline of 24.0%±5.0% to 31.0%±7.0% (P=0.002), tricuspid annular plane systolic excursion improved from (10.0±2.5) mm to (15.0±3.0) mm (P<0.001), fractional area change increased from 22.5%±6.0% to 30.0%±6.5% (P<0.001), and cardiac index rose from (1.9±0.4) L/(min·m2) to (2.8±0.5) L/(min·m2) (P<0.001). The average length of stay in the ICU was 7 (5, 10) days. No device malfunctions or bleeding events necessitating surgical re-exploration were recorded. Conclusion LVAD therapy provides effective cardiac unloading and enhances systemic perfusion in the perioperative setting, achieving a high rate of survival with the device. Clinical complications are generally manageable. Strengthening right heart evaluation and protection, alongside optimizing perioperative management protocols, holds the potential to further enhance patient outcomes.