ObjectiveTo summarize the clinical experience of totally thoracoscopic mitral valvuloplasty applied to cardiac surgery, and to evaluate its safety and efficacy. MethodsTwenty patients with mitral valve disease underwent totally thoracoscopic mitral valvuloplasty.The operation duration, duration for extracorporeal circulation and aortic occlusion, intraoperative blood loss, volume of postoperative chest drainage were recorded. The mortality and recovery of cardiac function during 19 months of the follow-up were also recorded. ResultsThe operation was successfully completed in all cases. No conversion to anterior median thoracotomy occurred in any patients. Successful mitral valvuloplasty at the first time was observed in 18 cases. In 2 cases, the efficacy of the first mitral valvuloplasty was poor, but the second plasty after re-occlusion was successful. The annuloplasty ring was used during operation in all patients. The other methods for mitral valvuloplasty included leaflet folding in 4 patients, commissure suture in 3 patients, artificial chordate in 10 patients and pericardial patch in 2 patients. The concomitant procedures included atrial septal defect or patent foramen ovale repair in 6 patients, tricuspid valvuloplasty in 10 patients, correction for anomalous drainage of right superior pulmonary vein in 1 patient, left atrial myxoma resection in 3 patients and mitral valve vegetation removal in 1 patient. The operation duration, duration for extracorporeal circulation and duration aortic occlusion were (259.50±48.88) minutes, (148.15±41.17) minutes and (85.15±20.74) minutes, respectively. The intraoperative blood loss and thoracic drainage volume within 24h after operation were (132.50±56.84) mL and (106.50±102.10) mL, respectively. The duration for indwelling thoracic tube was (2.75±0.79) days. The total blood transfusion volume was (206.00±202.70) mL. Transfusion with more stored blood due to more postoperative drainage volume occurred in 1 patient with dense pericardial adhesion. Another one patient was complicated with postoperative severe pulmonary infection and septic shock,but was cured by combined anti-infection. The duration for postoperative ventilator support, postoperative ICU stay and postoperative hospital stay were (7.15±5.17) hours, (26.50±9.62) hours, (9.70±4.51) days, respectively. No death was found. NO cases with obvious mitral stenosis or regurgitation were found by echocardiography before discharge. During the follow-up of (10.30±4.88) months, no death occurred. The cardiac function of the patients were improved (P＜0.05), and the postoperative cardiac function of grade Ⅰ was found in 19 cases and grade Ⅱ in 1 case. During the follow-up, mild mitral regurgitation was found in 1 patient by echocardiography. The left atrial dimension and left ventricular end-diastolic dimension were also significantly reduced compared to the preoperative dimension (P＜0.05). ConclusionTotally thoracoscopic mitral valvuloplasty becomes increasingly mature, and has the advantages including less trauma, blood loss and blood transfusion, fewer complications, faster recovery. This procedure is safe and effective, and is worthy of clinical application.

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