title: Minimally invasive video-assisted double-valve replacement through right anterolateral Minithoracotomy.
abstract: OBJECTIVE
  This study aimed to investigate feasibility and safety of minimally invasive video-assisted surgery for double-valve (mitral and aortic) replacement through right anterolateral minithoracotomy.
  
  
  METHODS
  Between February 2011 and April 2013, 60 patients with combined valvular disease underwent double valve replacement, 26 of them by minimally invasive video-assisted surgery through right anterolateral minithoracotomy (study group) and 34 by median sternotomy (control group). Peripheral cardiopulmonary bypass (CPB) was established through right femoral artery and vein. The incision was made around the right breast approximately 5 cm in length. Pericardiotomy, bicaval occlusion, atriotomy and aortotomy, and double valve replacement were performed with thoracoscope.
  
  
  RESULTS
  In the study group, times of CPB and aortic cross-clamp were 146.5 ± 40.5 min and 91.5 ± 23.4 min, respectively, which were significantly different from those in the control group, 115.4 ± 26.5 min and 75.4 ± 16.5 min (P<0.05). Thoracic drainage in the study group was significantly lower than the control group, 587 ± 245 ml (study group) versus 756 ± 267 ml (control group) (P<0.05). Length of ICU and postoperative hospital stay were shorter in the study group, 1.9 ± 0.8 and 8.7 ± 4.5 days versus 2.8 ± 1.3 and 11.2 ± 5.6 days in the control group (P<0.05), respectively. There was no statistical difference in the postoperative results of TTE (transthoracic echocardiography) (P>0.05). All patients recovered smoothly with follow-up of six months to two years, with no severe complications.
  
  
  CONCLUSIONS
  Minimally invasive video-assisted procedure through right anterolateral minithoracotomy is a new promising approach for double valve replacement. Our study suggested that this approach was feasible, safe and had cosmetic effects.
authors.affiliation: Shandong Provincial Key Laboratory of Cardiac Disease Diagnosis and Treatment, Department of Cardiac Surgery, Jining Medical University Affiliated Hospital, Jining 272029, Shandong, China.
authors.forename: Yanli
authors.initials: Y
authors.lastname: Qiao
authors.affiliation: Shandong Provincial Key Laboratory of Cardiac Disease Diagnosis and Treatment, Department of Cardiac Surgery, Jining Medical University Affiliated Hospital, Jining 272029, Shandong, China. Electronic address: anguoying9688@163.com.
authors.forename: Guoying
authors.initials: G
authors.lastname: An
authors.affiliation: Shandong Provincial Key Laboratory of Cardiac Disease Diagnosis and Treatment, Department of Cardiac Surgery, Jining Medical University Affiliated Hospital, Jining 272029, Shandong, China.
authors.forename: Guoqing
authors.initials: G
authors.lastname: Chen
authors.affiliation: Shandong Provincial Key Laboratory of Cardiac Disease Diagnosis and Treatment, Department of Cardiac Surgery, Jining Medical University Affiliated Hospital, Jining 272029, Shandong, China.
authors.forename: Shanguang
authors.initials: S
authors.lastname: Zheng
authors.affiliation: Shandong Provincial Key Laboratory of Cardiac Disease Diagnosis and Treatment, Department of Cardiac Surgery, Jining Medical University Affiliated Hospital, Jining 272029, Shandong, China.
authors.forename: Liangchun
authors.initials: L
authors.lastname: Ni
authors.affiliation: Shandong Provincial Key Laboratory of Cardiac Disease Diagnosis and Treatment, Department of Cardiac Surgery, Jining Medical University Affiliated Hospital, Jining 272029, Shandong, China.
authors.forename: Weixin
authors.initials: W
authors.lastname: Wang
authors.affiliation: Shandong Provincial Key Laboratory of Cardiac Disease Diagnosis and Treatment, Department of Cardiac Surgery, Jining Medical University Affiliated Hospital, Jining 272029, Shandong, China.
authors.forename: Linfeng
authors.initials: L
authors.lastname: Ma
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery; D002315:Cardiopulmonary Bypass; D003422:Critical Care; D004452:Echocardiography; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery; D056346:Sternotomy; D013908:Thoracotomy / Q000379:methods*; D013997:Time Factors
keywords: Double-valve replacement; Minimally invasion; Right anterolateral minithoracotomy; Thoracoscope; Valvular heart diseases