Minimally Invasive Port Access Versus Conventional Mitral Valve Surgery: Prospective Randomized Study (original) (raw)
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Eur J Cardio Thorac Surg, 1998
Objective: Using the initial experiences with the Port-Access TM technique for the treatment of mitral valve disease some changes were made thus resulting in more simple and faster procedures. Methods: Twenty-nine patients (13 male, 16 female, aged 30 to 75 years, median 62.5 ± 11.0 years) underwent minimally invasive mitral valve surgery between May 1996 and December 1997. The underlying diseases were: mitral valve insufficiency (n = 16), mitral valve stenosis (n = 7) and combined mitral valve disease (n = 6). Through a small right thoracotomy (5-7 cm) access to the pericardium and the heart was gained. Cardiopulmonary bypass was instituted through femoral cannulation and an intraaortic balloon-catheter was introduced for aortic occlusion, aortic root venting and delivery of cold crystalloid cardioplegia. Mitral valve repair (five patients) or replacement (24 patients) was performed. Results: There was no death during the whole follow-up period. There was no perivalvular leak and only minor residual mitral valve regurgitation was observed on intraoperative or postoperative (3 months) transesophageal echocardiography in three patients. There was no postoperative study-related complication. Time of ventilation and intensive care unit were comparable with the data of patients undergoing conventional mitral valve surgery but hospital stay was shorter in the last 10 consecutive cases. Conclusions: This simplified technique of mitral valve surgery combines the advantage of less invasive operative and good cosmetic results with the safety of conventional mitral valve surgery. At our institution this technique presents in well selected patients suffering from mitral valve disease the procedure of choice.
Is Minimally Invasive Mitral Valve Surgery Possible in Complex Patients
Background: Patients at high risk of preoperative morbidity and mortality, mitral valve endocarditis or prior cardiac surgery are considered "limiting" cases to undergo minimally invasive cardiac surgery. Objectives: The aim of this study was to assess the outcome of complex patients undergoing minimally invasive surgery. The primary endpoint was post-operative mortality at 30 days and the secondary endpoint was the analysis of technical-surgical results and early postoperative complications. Methods: The study consisted in the retrospective analysis of mitral valve surgeries performed at Hospital Italiano de Buenos Aires from January 2010 to April 2016. A total of 135 mitral valve surgeries, 63 by minimally invasive technique (46.6%) were performed. Forty-five patients (71.4%) were considered as "complex", including those with >10% STS-PROMM risk, active endocarditis, or prior cardiac surgery. Results: Surgeries were elective in 73.3% of cases (n=33), urgent in 22.2% (n=10) and emergent in 4.4% (n=2). Percent STS-PROM and %STS-PROMM were 6.08±10.8 and 26.7±16.8, respectively. Six patients with prior cardiac surgery and 5 with endocarditis in active treatment were included. Mitral valve replacement (14 rheumatic) was performed in 62% of patients (n=28) and mitral valve repair in 38% (n=17). No deaths were registered in mitral valve repair or mediastinitis. Mortality at 30 days was 4.4% (n=2) and conversion to sternotomy was necessary in one case. Conclusions: The observed mortality is lower than the one calculated by the risk score (%STS-PROMM 6.08±10.8 vs. 4.4). The right video-assisted minithoracotomy offered excellent exposure and interpretation of the disease. The minimally invasive surgical technique can be used in patients with prior cardiac surgery, endocarditis and/or patients with a high preoperative risk score.
The Journal of Thoracic and Cardiovascular Surgery, 2014
This study presents a review of our experience with minimally invasive mitral valve surgery (MIMVS) in patients with a previous cardiac procedure performed through a sternotomy over a 10-year period. Methods: From November 2003 to August 2013, 173 patients (age 61.3 AE 12.4 years) underwent reoperative MIMVS through a right minithoracotomy. Previous operations were coronary artery bypass grafting (n ¼ 49; 28.6%), a mitral valve procedure (n ¼ 120; 70.1%), an aortic valve procedure (n ¼ 32; 18.7%), and other operations (n ¼ 14; 8.1%). The mean euroSCORE was 11.2 AE 3.8. The time to redo surgery was 6.9 AE 4.2 years. Results: Procedures were performed with central aortic cannulation in 55 patients (31.7%) and peripheral cannulation in 118 (68.3%). A transthoracic clamp was used in 58 patients (33.5%), an endoaortic balloon in 72 (41.6%), hypothermic ventricular fibrillation in 23 (13.2%), and beating heart in 20 (11.5%). Mean cardiopulmonary bypass and crossclamp times were 160 AE 58 minutes and 82 AE 49 minutes, respectively. Mitral repair was performed in 53 patients (30.6%). Forty-three patients (24.7%) had an additional cardiac procedure. Conversion to sternotomy was necessary in 2 patients (1.1%) and reoperation for bleeding in 11 patients (6.3%). Thirty-day mortality was 4.1% (n ¼ 7). Major morbidities included stroke (n ¼ 11; 6%) and new-onset dialysis requirement (n ¼ 4; 2.3%). The mean blood transfusion requirement was 1.4 AE 1.1 units. Mean follow-up was 3.3 AE 2.6 years. Survival at 1, 5, and 10 years was 93.1% AE 1.9%, 87.5% AE 2.7%, and 79.7% AE 3.8%, respectively. Conclusions: Reoperative mitral valve surgery can be safely performed through a right minithoracotomy with good early and late outcomes. The avoidance of extensive surgical dissection, optimal valve exposure, and low blood transfusion are the main advantages of this technique.
Early outcome of minimally invasive mitral valve surgery
Journal of the Egyptian Society of Cardio-Thoracic Surgery, 2016
Background: Minimally invasive mitral valve surgery (MIMVS) is safe, with low perioperative morbidity, and low rates of reoperation. Minimally invasive mitral valve surgery has been proven a feasible alternative to the conventional full sternotomy approach with low perioperative morbidity and short-term mortality. Efforts to minimize surgical trauma, hasten patient recovery, increase patient satisfaction, and reduce cost without compromise to surgical repair or replacement techniques, continue to be the rationale for minimally invasive procedures. Methods: In this study 30 patients with mitral valve disease (MVD) requiring mitral valve surgery selected by purposive non probability sample. The study was done at the Armed Forces Hospitals (mainly Maadi & Galaa Armed Forces Hospitals). 15 patients attended to do mitral valve surgery by traditional sternotomy (group B), other 15 patients by less invasive surgery (Rt. anterolateral mini-thoracotomy) (group A) with femoral artery and vein cannulation. Results: There was no statistical difference between the two groups preoperatively regarding their age, sex, NYHA class, EF%, LA dimension, spirometric study. There was no operative mortality in both groups but fewer postoperative complications occurred in both groups. Total hospital stay, ICU stay, postoperative bleeding, inotropic requirement, ventilatory support, blood transfusion was less in group "A", with better cosmetic appearance, and more cost effective. Conclusion: Right anterolateral mini-thoracotomy minimally invasive technique provides excellent exposure of the mitral valve, even with a small atrium and offers a better cosmetic lateral scar which is less prone to keloid formation. In addition, minimally invasive right anterolateral mini-thoracotomy is as safe as median sternotomy for mitral valve surgery, with fewer complications and postoperative pain, less ICU and hospital stay, fast recovery to work with no movement restriction after surgery. It should be
Minimally Invasive Mitral Valve Surgery: An Update
Minimally invasive mitral valve surgery (MIMVS) was introduced in the mid-1990s to refer to a variety of surgical techniques that avoid full sternotomy through smaller or alternative chest wall incisions, as an attempt to reduce complications, but at the same time preserve outcomes of the full sternotomy approach. In this review, different aspects of MIMVS are discussed in relation to its approaches (right parasternal incision, lower ministernotomy, right anterolateral minithoracotomy and left posterior minithoracotomy) as well as strategies (mini-incisions, video-assistance, video direction with robotic assistance and telemanipulation) passing through more than 2 decades of continuous evolution. In the current practice MIMVS shows similar outcome to conventional surgery with even more superior results regarding blood loss, ICU and hospital stay, as well as functional recovery. The accumulating experience with MIMVS encouraged surgeons to extend the application of these techniques to high-risk patients, redo surgeries, concomitant double or triple valve procedures as well as combined coronary artery and mitral valve diseases in a hybrid approach, reducing the need for full median sternotomy. In addition there is an emerging trend of transcatheter valve implantation in the mitral position with small reports of valve-in valve or valve-in-ring implantation as well as valve replacement in case of severe MAC. This new trend may establish itself in the future as a modality in treating native mitral valve diseases in high risk patients. Therefore it is recommended for cardiac centers to build up a program for MIMVS in order to fulfill the recent requirements of cardiac surgery.