Minimally Invasive Approach for Redo Mitral Valve Surgery: A True Benefit for the Patient (original) (raw)
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Safety of Minimally Invasive Mitral Valve Surgery Without Aortic Cross-Clamp
The Annals of Thoracic Surgery, 2008
Methods. One hundred and ninety-five consecutive patients 103 male and 92 female), age 69 ؎ 8 years, underwent surgery between January 2006 and July 2007. Mean preoperative New York Heart Association function class was 2.2 ؎ 0.7. Thirty-five patients (18%) had an ejection fraction 0.35 or less. Cardiopulmonary bypass was instituted through femoral (176 of 195, 90%), axillary (18 of 195, 9%), or direct aortic (1 of 195, 0.5%) cannulation. Under cold fibrillatory arrest (mean temperature 28.2°C) without aortic cross-clamp, mitral valve repair (72 of 195, 37%), mitral valve replacement (117 of 195, 60%), or other (6 of 195, 3%) procedures were performed. Concomitant procedures included maze (45 of 195, 23%), patent foramen ovale closure (42 of 195, 22%) and tricuspid valve repair (16 of 195, 8%), or replacement (4 of 195, 2%). . Duration of fibrillatory arrest, cardiopulmonary bypass, and "skin to skin" surgery were 88 ؎ 32, 118 ؎ 52, and 280 ؎ 78 minutes, respectively. Ten patients (5%) underwent reexploration for bleeding and 44% did not receive any blood transfusions. Six patients (3%) sustained a postoperative stroke, eight (4%) developed low cardiac output syndrome, and two (1%) developed renal failure requiring hemodialysis. Mean length of hospital stay was 7 ؎ 4.8 days.
Redo mitral valve replacement through a right mini-thoracotomy with an unclamped aorta
Multimedia Manual of Cardio-Thoracic Surgery, 2014
Redo cardiac surgery represents a clinical challenge due to a higher rate of perioperative morbidity and mortality. Mitral valve (MV) re operations can particularly be demanding in patients with patent coronary grafts, previous aortic valve replacement, calcified aorta or complications following a previous operation (abscesses, leaks or thrombosis). In this article we describe our technique to manage complex mitral reoperations using a minimally invasive approach, moderate hypothermia and avoiding aortic cross-clamping. Minimally invasive procedures with an unclamped aorta have the potential to combine the benefits of less invasive access and continuous myocardial perfusion. The advantage of a right mini-thoracotomy is the avoidance of sternal re-entry and limited dissection of adhesions, reducing the risk of cardiac structures or patent graft injury. Moderate hypothermia and continuous blood perfusion can guarantee adequate myocardial protection particularly in the case of patent grafts, decreasing the dangers of an incomplete or imperfect aortic clamping at mild hypothermia and potential lesions due to demanding clamp placing. Complex MV reoperations can be safely and effectively performed through a smaller right thoracotomy in the fourth intercostal space with an unclamped aorta.
Interactive cardiovascular and thoracic surgery, 2009
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'Is a minimally invasive approach superior to standard sternotomy for re-operative mitral valve surgery?'. Altogether 48 papers were found using the reported search, of which 9 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that minimally invasive mitral valve re-operation can be performed with an operative mortality similar to standard sternotomy approach but with a higher patient satisfaction. Less postoperative bleeding, reduced need for blood transfusion and absence of sternal wound infection are the main advantages of this technique. Mean hospital stays and ventilation time appear to be reduced with this approach.