ĐÁNH GIÁ TÍNH AN TOÀN, KHẢ THI, KẾT QUẢ SỚM VÀ TRUNG HẠN CỦA PHẪU THUẬT TIM ÍT XÂM LẤN TRONG ĐIỀU TRỊ BỆNH VAN HAI LÁ HẬU THẤP

Abstract

Objective: This study assesses the safety, feasibility, and early to mid-term outcomes of minimally invasive cardiac surgery for rheumatic mitral valve disease. Material and Methods: We retrospectively analyzed 125 patients with rheumatic mitral valve disease who underwent minimally invasive mitral valve replacement via right thoracotomy from January 2019 to December 2022. Results: The patients' average age was 52.9 ± 10.4 years, with 69.6% females. Eighty percent were admitted due to exertional dyspnea, and 71.2% had NYHA II heart failure preoperatively. Echocardiograms revealed characteristic rheumatic mitral valve lesions in 96.8%, predominantly stenosis with valve regurgitation (84.8%). The mean left ventricular ejection fraction was 56.9 ± 6.0%. EuroSCORE II-assessed mortality was 2.2 ± 1.4%. Cardiopulmonary bypass (CPB) and aortic cross-clamp (ACC) times averaged 144.4 and 92.2 minutes, respectively, with a 0.8% conversion rate to sternotomy. Mechanical mitral valve replacement was done in 63.1% of cases. Average mechanical ventilation and ICU times were 21.2 and 72.3 hours, respectively. Four percent required reoperation for bleeding, and 3.2% resulted in in-hospital mortality, with 0.8% due to Takotsubo cardiomyopathy. Factors affecting 30-day post-surgery mortality included CPB duration. At a medium-term follow-up (14.4 months), mortality was 1.7%, with a two-year survival rate of 98.3%. Conclusion: Minimally invasive mitral valve replacement via right thoracotomy is a safe and effective approach for managing rheumatic valve disease. During initial adoption, careful patient selection, especially focusing on younger individuals with fewer comorbidities, is essential.