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The first case of minimally invasive cardiac surgery of Bentall combined with mitral valvuloplasty in China

Updated: Apr 25, 2021
From: Department of Cardiovascular Surgery
Edited by: Liu Huiting

On April 19, the team led by Yan Yang from Department of Cardiovascular Surgery of the First Affiliated Hospital of Xi 'an Jiaotong University (XJTU) successfully completed the "minimally invasive aortic root replacement combined with mitral valvuloplasty" under intimate cooperation with Department of Anesthesia and Cardiac Ultrasound Room. During this innovative procedure, the right thoracic intercostal approach was adopted to avoid sternal fracture, which yielded mild intraoperative bleeding loss, created a small incision of 6cm in size and mitigated surgical trauma to the greatest extent. The success of this extremely challegening surgery is the first case in China.

A 52-year-old patient, surnamed Sun, presented with shortness of breath accompanied with chest pain and dry cough for 5 months with unknown causes. Relevant symptoms could be relieved after a few minutes of rest. The patient was diagnosed with heart valve disease, aortic valve insufficiency complicated with mitral valve insufficiency in a local hospital. These symptoms were significantly worsened for 1 month and the patient had to take a rest after walking a few steps. The patient was subsequently transferred to the First Affiliated Hospital of XJTU. After careful evaluation and comprehensive analysis of the disease condition, Cardiovascular Surgery Team additionally identified the incidence of heart valve abnormality and aneurysm-like dilatation of the ascending aorta with an inner diameter of 54 mm. After repeated consultation, the expert team was determined to adopt the surgical regime of "minimally invasive aortic root replacement combined with mitral valvuloplasty" to resect the ascending aortic aneurysm and repair the diseased heart valve. Meantime, a minimally invasive surgery was adopted to minimize the degree of surgical trauma and shorten the length of hospital stay.

Minimally invasive aortic root replacement is a highly challenging surgery in the field of cardiac surgery. In addition, since the patient was complicated with mitral valve insufficiency, it was a highly demanding procedure for the visual acuity, surgical skill and endurance of the surgeons to perform "aortic root replacement combined with mitral valvuloplasty" using a small incision of 6-7cm.

On April 19, the patient was transferred to Operation Room. Preoperatively, the valvular lesion was confirmed in Cardiac Ultrasound Room. Professor Yan Yang served as the chief surgeon under intimate cooperation with Department of Anesthesia and Cardiopulmonary Bypass Team. After cardiopulmonary bypass was established, subcutaneous tissues and muscles were separated layer-by-layer via the third intercostal approach of the right chest, and the mitral valve was carefully explored. The mitral annulus of the patient was enlarged, the leaflets were in normal condition and central regurgitation of the cardiac valve was observed. To alleviate relevant complications after valve replacement, improve the quality of life, and maximize clinical benefits, Director Yan Yang decisively performed mitral valvuloplasty with a higher degree of difficulty, and achieved excellent surgical effect. During the exploration of aortic valve, the signs of valve thickening and significant dilation of aortic could be seen. Then, the diseased aortic valve was resected, a No.25 valved artificial vessel was implanted and the anastomosis of bilateral coronary openings was gradually completed.

The surgery was successfully completed after 6 h of collective efforts. The intraoperative hemorrhage amount was only 100ml, and the drainage amount was 80ml within postoperative 24 h. All parameters of the patient remained stable. According to our knowledge, this is the first case of "minimally invasive aortic root replacement combined with mitral valvuloplasty" in China, providing a novel minimally invasive surgical optionfor patients with these heart diseases.

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