Minimal invasive approach in mitral valve surgery: Evolving method which requires higher experience and skills

Background: Minimally invasive mitral valve surgery became an attractive option because of its cosmetic advantages over the conventional approach. The superiority of the minimally invasive approach regarding other aspects is still debatable. The aim of our study was to determine the potential benefits of minimally invasive mitral valve replacement with intraoperative video assistance over conventional surgery. Methods: This is a single-center prospective cohort study that included 60 patients with rheumatic heart disease who underwent mitral valve replacement. Patients were divided into two groups: group (A) included patients who had conventional sternotomy (n= 30), and group (B) included patients who had video-assisted minimally invasive mitral valve replacement (n= 30). Intraoperative and postoperative outcomes were compared between both groups. Results: Mortality occurred in one patient in the group (A). Cardiopulmonary bypass time was 118.93 ± 29.84 minutes vs. 64.73 ± 19.16 minutes in group B and A respectively (p< 0.001), and ischemic time was 102.27 ± 30.03 minutes vs. 53.67± 18.46 minutes in group B and A respectively (P < 0.001). Ventilation time was 2.77± 2.27 vs. 6.28 ± 4.48 hours in group B and A respectively (p< 0.001) and blood transfusion was 0.50 ± 0.63 vs. 2.83 ± 1.34 units in group B and A respectively (p< 0.001). ICU stay was 1.73 ± 0.64 days in the group (B) vs. 4.47 ± 0.94 days in group A (p< 0.001). Postoperative bleeding was 353.33 ± 146.77 ml in the group (B) vs. 841.67 ± 302.03 ml in group A (p <0.001). No conversion to full sternotomy was reported in group B. In group (B), two cases (6.6%) required re-exploration for bleeding vs. four cases (13.2%) in group (A) (p=0.67). The hospital stay was 6.13 ± 1.59 days in the group (B) vs. 13.27 ± 7.62 days in group A (p< 0.001). Four cases (13.3%) developed mediastinitis in group A and in the group (B), there was one case of acute right lower limb embolic ischemia. Conclusion: Video-assisted minimally invasive mitral operations could be a safe alternative to conventional sternotomy with the potential of lesser morbidity and earlier hospital discharge.

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Temporary Neurological Dysfunction After Minimal Invasive Mitral Valve Surgery: Influence of Type of Perfusion and Aortic Clamping Technique

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2016.07.007 ◽

2017 ◽

Vol 103 (2) ◽

pp. 691-692 ◽

Cited By ~ 4

Author(s):

Cristina Barbero ◽

Giovanni Marchetto ◽

Davide Ricci ◽

Mauro Rinaldi

Keyword(s):

Mitral Valve ◽

Mitral Valve Surgery ◽

Minimal Invasive ◽

Valve Surgery ◽

Neurological Dysfunction ◽

Aortic Clamping

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Abstract 14956: Improved Operative Efficiency for Minimally Invasive Mitral Valve Surgery at a Low-volume Center

Circulation ◽

10.1161/circ.142.suppl_3.14956 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Monica Fowler ◽

Jeffrey B MacLeod ◽

christie aguiar ◽

Alexandra M Yip ◽

zlatko pozeg ◽

...

Keyword(s):

Cardiac Surgery ◽

Mitral Valve ◽

Minimally Invasive ◽

High Volume ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Entire Study ◽

Invasive Approach ◽

Low Volume ◽

Skin To Skin

Introduction: When implementing a minimally invasive cardiac surgery program, increased surgical times may serve as a deterrent. Results demonstrating parity in operative times between minimally invasive (MIMVR) and conventional mitral valve replacement/repair (CMVR) have been limited to high-volume centers. The purpose of this study was to examine operative efficiency for MIMVR in a low-volume center. Methods: All patients having undergone non-emergent, isolated MIMVR or CMVR at the New Brunswick Heart Centre from 2011-2017 were considered. Detailed peri-operative data, including cross clamp (XC), cardiopulmonary bypass (CPB), skin-to-skin (SS) and total operative (TO) times, were collected. Patients were assigned to one of 3 eras: 2011-2013, 2014-2015, 2016-2017. Unadjusted comparisons were made between MIMVR and CMVR over the entire study period and within each era. Results: A total of 168 patients were included (MIMVR: 64; CMVR: 104). There was an increase in the number of MIMVR cases over time (2011-2013: 19; 2014-2015: 17; 2016-2017: 28). Patients undergoing MIMVR were less likely to be ≥70years (29.7% vs. 47.1%, p=0.04) and to have had NYHA-IV symptoms (17.2% vs. 41.3%, p=0.002), previous cardiac surgery (4.7% vs. 23.1%, p=0.003) or urgent presentation (12.5% vs. 35.6%, p=0.002). Intra-operatively, MIMVR patients were more likely to have undergone a mitral valve repair (65.1% vs. 29.1%, p<0.0001). No differences were noted in rates of in-hospital mortality (0.0% vs. 5.1%, p=0.29). Median operative times were uniformly longer among MIMVR patients between 2011-2013. However, in 2014-2015 and 2016-2017, these times improved to the point where no significant differences in operative efficiency were noted (Figure). Conclusions: Improved operative efficiency may be safely achieved for MIMVR in a low-volume center. The results of this study should encourage low-volume centers to adopt a minimally invasive approach to isolated mitral valve surgery.

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Obesity Should Not Deter a Surgeon from Selecting a Minimally Invasive Approach for Mitral Valve Surgery

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0b013e3182a20e5a ◽

2013 ◽

Vol 8 (3) ◽

pp. 225-229 ◽

Cited By ~ 9

Author(s):

Diana Reser ◽

Simon Sündermann ◽

Jürg Grünenfelder ◽

Jacques Scherman ◽

Burkhardt Seifert ◽

...

Keyword(s):

Mitral Valve ◽

Minimally Invasive ◽

Mitral Valve Surgery ◽

Normal Weight ◽

Valve Surgery ◽

Cerebrovascular Event ◽

Minimally Invasive Approach ◽

Term Outcome ◽

Invasive Approach ◽

Postoperative Ventilation

Objective Obesity is highly prevalent in modern patient populations. Several studies have published conflicting outcomes after minimally invasive surgery with regard to morbidity and mortality. Some instances consider obesity as a relative contraindication for this approach because of inadequate exposure of the surgical field. Our aim was to investigate the outcomes of minimally invasive mitral valve surgery through a right lateral minithoracotomy in patients with a body mass index (BMI) of 30 kg/m2 or greater. Methods We conducted a retrospective database review between January 1, 2009, and December 31, 2011. Preoperative, intraoperative, postoperative, and follow-up data of 225 consecutive patients were collected. Results The patients were stratified according to their BMI: 108 had a normal weight with a BMI of lower than 25 kg/m2 (18–24), 90 were overweight with a BMI of 25 to 29 kg/m2, and 27 were obese with a BMI of 30 kg/m2 (30–41) or greater. Statistical analysis showed significantly longer ventilation times in the obese group, whereas all other variables were similar. Survival, major adverse cardiac and cerebrovascular event-free survival, valve competency, and freedom from reoperation were also comparable. Conclusions Our data suggest that obesity should not deter a surgeon from selecting a minimally invasive approach. Despite longer postoperative ventilation times, a BMI of 30 kg/m2 or greater does not influence short- and medium-term outcome. Obese patients may even benefit from this approach because it avoids the need for sternotomy and therefore reduces the risk for sternal wound infection.

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Is a minimally invasive approach for re-operative mitral valve surgery superior to standard resternotomy?

Interactive Cardiovascular and Thoracic Surgery ◽

10.1510/icvts.2009.203448 ◽

2009 ◽

Vol 9 (2) ◽

pp. 327-332 ◽

Cited By ~ 12

Author(s):

M. Murzi ◽

M. Solinas ◽

M. Glauber

Keyword(s):

Mitral Valve ◽

Minimally Invasive ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Minimally Invasive Approach ◽

Invasive Approach

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Minimally invasive approach for aortic and mitral valve surgery

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezw208 ◽

2016 ◽

Vol 50 (6) ◽

pp. 1204-1205 ◽

Cited By ~ 6

Author(s):

Antonio Lio ◽

Antonio Miceli ◽

Matteo Ferrarini ◽

Mattia Glauber

Keyword(s):

Mitral Valve ◽

Minimally Invasive ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Minimally Invasive Approach ◽

Invasive Approach

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Minimal invasive mitral valve surgery does make a difference: Should it be the gold standard for mitral valve repair?

Trends in Cardiovascular Medicine ◽

10.1016/j.tcm.2015.02.008 ◽

2015 ◽

Vol 25 (5) ◽

pp. 466-468

Author(s):

Danny Ramzy ◽

Alfredo Trento

Keyword(s):

Mitral Valve ◽

Mitral Valve Repair ◽

Gold Standard ◽

Mitral Valve Surgery ◽

Minimal Invasive ◽

Valve Surgery ◽

Valve Repair

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Minimally invasive versus sternotomy mitral valve surgery when initiating a minimally invasive programme

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa232 ◽

2020 ◽

Vol 58 (6) ◽

pp. 1168-1174

Author(s):

Mikael Kastengren ◽

Peter Svenarud ◽

Göran Källner ◽

Anders Franco-Cereceda ◽

Jan Liska ◽

...

Keyword(s):

Mitral Valve ◽

Propensity Score ◽

Minimally Invasive ◽

Propensity Score Matching ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Minimally Invasive Procedures ◽

Invasive Procedures ◽

Short Term ◽

Invasive Approach

Abstract OBJECTIVES An increasing number of mitral valve operations are performed using minimally invasive procedures. The initiation of a minimally invasive mitral valve surgery programme constitutes a unique opportunity to study outcome differences in patients with similar characteristics operated on through a sternotomy versus a minimally invasive procedure. The goal of this study was to compare short-term outcomes of patients undergoing mitral valve surgery before versus those having surgery after the introduction of a minimally invasive programme. METHODS The single-centre study included mitral valve procedures performed through a sternotomy or with a minimally invasive approach between January 2012 and May 2019. Propensity score matching was performed to reduce selection bias. RESULTS A total of 605 patients (294 sternotomy, 311 minimally invasive) who underwent mitral valve surgery were included in the analysis. Propensity score matching resulted in 251 matched pairs. In the propensity score-matched analysis, minimally invasive procedures had longer extracorporeal circulation duration (149 ± 52 vs 133 ± 57 min; P = 0.001) but shorter aortic occlusion duration (97 ± 36 vs 105 ± 40 min, P = 0.03). Minimally invasive procedures were associated with a lower incidence of reoperation for bleeding (2.4% vs 7.2%; P = 0.012), lower need for transfusion (19.1% vs 30.7%; P = 0.003) and shorter in-hospital stay (5.0 ± 2.7 vs 7.2 ± 4.6 days; P < 0.001). The 30-day mortality was low in both groups (0.4% vs 0.8%; P = 0.56). CONCLUSIONS Minimally invasive mitral valve surgery was associated with short-term outcomes comparable to those with procedures performed through a sternotomy. Initiating a minimally invasive mitral valve programme with a limited number of surgeons and a well-executed institutional selection strategy did not confer an increased risk for adverse events.

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