Optimization effect of minimally invasive thoracoscopic aortic valve replacement on postoperative intensive care of patients
Objective This study aimed to analyze the optimization effect of minimally invasive thoracoscopic surgery(MIs)for aortic valve replacement(AVR)on postoperative intensive care of patients by using the propensity score inverse probability weighting method.Methods A total of 266 patients who underwent AVR surgery at Zhejiang Provincial People's Hospital from August 2019 to June 2022 were selected.Among them,117 patients received MIs(MIs group),and 149 patients received conventional surgery(MS group).After surgery,all patients were admitted to the intensive care unit for treatment.Baseline data of the two groups were compared.The patients in both groups were matched using the propensity score inverse probability weighting method to ensure that their baseline characteristics were comparable without statistical differences.Subsequently,the duration of intensive care and the occurrence of postoperative complications during intensive care were compared between the matched groups.These complications included poor wound healing,arrhythmia,pneumonia,pleural effusion,stroke,low cardiac output syndrome,and death.Additionally,secondary outcome measures such as the use of interventions like aortic balloon counterpulsation,extracorporeal membrane oxygenation,tracheostomy,duration of mechanical ventilation,total drainage volume in the surgical area,plasma volume,platelet volume,red blood cell volume,total use of blood products,surgical cost,total cost,and total hospitalization time were also assessed.Results There were no statistically significant differences in the baseline data of acute physiology and chronic health evaluation,height,gender,age,infective endocarditis,rheumatic heart disease,cardiomyopathy,and others between the two groups(all P＞0.05).Compared with the MS group,patients in the MIs group exhibited lower body mass index,lighter body weight,varied New York Heart Association classification,higher prevalence of coronary heart disease,shorter cardiopulmonary bypass time,and shorter cross-clamp time(all P＜0.05).After matching the baseline data of the two groups of patients using propensity score inverse probability weighting method,there were no statistically significant differences in the baseline data comparison between the two groups(all P＞0.05).After matching the baseline data of the two groups of patients,the MIs group showed a shorter duration of intensive care than the MS group(26 h vs.70 h,x2=174.763,P＜0.01).There were no statistically significant differences between two groups in poor wound healing,arrhythmia,pneumonia,pleural effusion,low cardiac output syndrome,death,aortic balloon counterpulsation,extracorporeal membrane oxygenation,tracheostomy,plasma volume,platelet volume,red blood cell volume,blood product volume,surgical cost,etc.(all P＞0.05).Compared with the MS group,the Mls group had fewer strokes,shorter mechanical ventilation time,less drainage volume in the surgical area,reduced total hospitalization costs,and shorter total hospitalization time,etc.(all P＜0.05).Conclusion Under the same baseline level,AVR surgery performed with Mls can optimize postoperative care compared with conventional surgery,which can not only shorten the duration of intensive care,mechanical ventilation support time,and total hospitalization time,but also reduce postoperative drainage,incidence of postoperative stroke complications,and total hospitalization costs.
ThoracoscopesMinimally invasive surgical proceduresIntensive care unit
万方数据
维普
