Right Mini-Thoracotomy for Aortic Plus Mitral with or without Tricuspid Valve Surgery

2020 ◽  
Author(s):  
Gloria Faerber ◽  
Sophie Tkebuchava ◽  
André Scherag ◽  
Maximilian Bley ◽  
Hristo Kirov ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Propensity Score ◽  
Minimally Invasive ◽  
Propensity Score Matching ◽  
Tricuspid Valve ◽  
Valve Surgery ◽  
Tricuspid Valve Surgery ◽  
Triple Valve ◽  
Mini Thoracotomy

Abstract Objectives Minimally invasive surgery is increasingly performed for isolated aortic or mitral valve procedures. However, combined minimally invasive aortic and mitral valve surgery is rare. We report our initial experience performing multiple valve procedures through a right-sided mini-thoracotomy (RMT) compared with sternotomy. Methods A total of 264 patients underwent aortic and mitral with or without tricuspid valve surgery through RMT (n = 25) or sternotomy (n = 239). Propensity score matching was used for outcome comparisons. Results Of the 264 patients, 25 (age: 72 ± 10 years; 72% male) underwent double (n = 19) and triple valve surgery (n = 6) through RMT and 239 (age: 71 ± 11 years; 54% male) underwent double (n = 176) and triple valve surgery (n = 63) through sternotomy. Sternotomy patients had more co-morbidities and preoperative risk factors (EuroSCORE II 10.25 ± 10.89 vs. RMT 3.58. ± 4.98; p < 0.001). RMT procedures were uneventful without intraoperative complications or conversions to sternotomy. After propensity score matching, surgical procedures were comparable between groups with a higher valve repair rate in RMT. Despite longer cardiopulmonary bypass times in RMT, there was no evidence for differences in 30-day mortality (RMT: n = 2 vs. sternotomy: n = 2) and there were no significant differences in other outcomes. During 5-year follow-up, reoperation was required in sternotomy patients only (n = 2). Follow-up echocardiography showed durable results after valve surgery. RMT patients showed higher survival probability compared with sternotomy, although this difference was not significant (hazard ratio = 0.33; 95% confidence interval: 0.06–1.65; p = 0.18). Conclusion Combined aortic plus mitral with or without tricuspid valve surgery can safely be performed through a RMT with a trend toward better mid-term outcomes.

scholarly journals Simplified Minimally Invasive Beating Heart Technique for Redo Isolated Tricuspid Valve Surgery

2020 ◽  
Author(s):  
Shuyang Lu ◽  
Kai Song ◽  
Wangchao Yao ◽  
Limin Xia ◽  
Lili Dong ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Minimally Invasive ◽  
Valve Replacement ◽  
Tricuspid Valve ◽  
Beating Heart ◽  
Valve Surgery ◽  
Midterm Results ◽  
Tricuspid Valve Surgery ◽  
Cardiac Operations

Abstract BackgroundRedo isolated tricuspid valve surgery has been associated with a high morbidity and mortality, and its optimal timing of surgical intervention remains controversial. Hence, we reviewed our early and midterm results with a simplified minimally invasive beating heart technique for isolated redo tricuspid valve surgery in patients at high risk.MethodsBetween June 2016 and August 2017, a total of 14 consecutive patients underwent isolated tricuspid valve operations after previous cardiac operations with minimally invasive beating heart technique through a right lateral thoracotomy in our center. Mean patient age was 54.0 ± 8.3 years, and 9 patients (64.3%) were women. Mean preoperative EuroSCORE was 8.1 ± 1.3 (6 to 11). Previous cardiac operations included 6 patients (42.9%) with mitral valve replacement, 1 patient (7.1%) with mitral valve replacement and tricuspid valve repair, 1 patient (7.1%) with tricuspid valve replacement, 5 patients (35.7%) with mitral valve and aortic valve replacement, and 1 patient (7.1%) with Ebstein repair. Midterm follow-up was complete for 12 patients (85.7%).ResultsBoth in-hospital and thirty-day mortalities were 0%. Tricuspid valve replacement with bioprosthesis was performed in 12 patients (85.7%), and the remaining 2 patients (14.3%) underwent tricuspid repair (annuloplasty and leaflets reconstruction). Mean cardiopulmonary bypass time was 55.6 ± 10.7 minutes. Overall in-hospital duration and intensive care unit (ICU) time were 11.6 ± 8.8 days, 3.9 ± 2.8 days, respectively. Postoperative complications included 2 patients (1.4%) with prolonged ventilation, and 2 patients (1.4%) with acute kidney injury. There were no postoperative cerebrovascular accidents, myocardial infarctions, reoperations for bleeding, or deep wound infections. All patients were discharged uneventful. Except 2 patients lost follow-up, there were no adverse cardiovascular events and deaths occurred in other patients.ConclusionsSimplified minimally invasive beating heart technique for redo tricuspid valve surgery is both feasible and safe, and the early and midterm results are excellent.

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

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 &lt; 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.

scholarly journals Minimally Invasive Isolated Tricuspid Valve Repair: the Trend for Redo Tricuspid Valve Surgery

2021 ◽  
Author(s):  
Xiaoyi Dai ◽  
Peng Teng ◽  
Sihan Miao ◽  
Wei Si ◽  
Qi Zheng ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Nyha Class ◽  
Valve Surgery ◽  
Tricuspid Valve Repair ◽  
Valve Repair ◽  
Tricuspid Valve Surgery ◽  
The Mean

Abstract Background: Tricuspid regurgitation after left-sided valve surgery was associated with terrible outcomes and high perioperative mortality for redo surgical treatment. In current years, minimally invasive redo isolated tricuspid valve repair is increasingly performed in our institution to address tricuspid regurgitation. Methods: Thirty-seven consecutive patients with previous left-sided valve surgery underwent minimally invasive redo isolated tricuspid valve repair in our institution between November 2017 and December 2020. Twenty-nine patients(78.4%) were women and the mean age of patients was 58.4±8.5 years. Follow-up was 100% complete with a mean follow-up time of 16.8±9.4 months.Results: Both the in-hospital and 30-day mortalities were 2.7%. The overall NYHA class had improved significantly during the follow-up(p＜0.001). The grade of TR had decreased before discharge(p＜0.001) and during the follow-up(p＜0.001) compared with the preoperative level although severe TR was recurrent in one patient.Conclusions: Minimally invasive redo isolated tricuspid valve repair has remarkable early and midterm outcomes, may be the preferred surgical option to address tricuspid regurgitation after previous left-sided valve surgery when it is feasible.

scholarly journals Longitudinal echocardiographic and clinical follow-up of patients undergoing mitral valve surgery without concomitant tricuspid valve repair

2018 ◽  
Vol 26 (11) ◽  
pp. 552-561 ◽  
Author(s):  
R. Jansen ◽  
B. R. van Klarenbosch ◽  
M. J. Cramer ◽  
R. C. A. Meijer ◽  
P. H. M. Westendorp ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Tricuspid Valve ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Tricuspid Valve Repair ◽  
Valve Repair
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