scholarly journals Minimally Invasive versus Conventional Approach for Mitral Valve Surgery

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A B ElKerdany ◽  
M A Elghanam ◽  
M A Gamal ◽  
T M E Abdelmoneim
Keyword(s):  
Mitral Valve ◽  
Minimally Invasive ◽  
Mitral Valve Disease ◽  
Meta Analysis ◽  
Median Sternotomy ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Valve Disease ◽  
Standard Approach ◽  
Perioperative Outcomes

Abstract Introduction Full median sternotomy has been well established as a standard approach for all types of open heart surgery for many years. Although well established, the full sternotomy incision has been frequently criticized for its length, post operative pain and possible complications. Minimally invasive mitral valve surgery can be an appealing feasible alternative to the conventional full sternotomy approach with low perioperative morbidity and short-term mortality. We here made meta-analysis to compare perioperative outcomes of MIMVS versus CMVS in patients with mitral valve disease. Methods A systematic review of studies comparing perioperative outcomes of MIMVS versus CMVS in patients with mitral valve disease, from 2012 up to 2017. Review Manager 5.2 (Cochrane Collaboration) was employed to analyze the results. The outcomes of interest are mortality, cerebrovascular accidents, wound infection, reexploration due to bleeding, and LVEF assessment post-surgery. Results 12 studies involving 10279 patients were included in the meta-analysis. The 30-day mortality was significantly decreased with MIMVS; 1.6% in the MIMVS group and 2.9% in the group treated through a conventional sternotomy. Cerebrovascular events were significantly decreased with MIMVS; the stroke rate was 0.9% in MIMVS patients and 3% in patients treated via a conventional sternotomy. Wound infections, reexploration due to bleeding, and LVEF did not differ significantly between both groups. Conclusion The perioperative outcome is more or less similar for minimally invasive mitral valve surgery and conventional mitral valve surgery performed via median sternotomy. Given balance in outcomes, MIMVS is at least as safe as the standard approach and can be considered a routine and standard approach for mitral valve surgery.

scholarly journals Totally endoscopic mitral valve surgery: early experience in 188 patients

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Yi Chen ◽  
Ling-chen Huang ◽  
Dao-zhong Chen ◽  
Liang-wan Chen ◽  
Zi-he Zheng ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Minimally Invasive ◽  
Mitral Valve Disease ◽  
Median Sternotomy ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Valve Disease ◽  
Endoscopic Technique ◽  
Venous Cannula ◽  
Defect Repair

Abstract Introduction Totally endoscopic technique has been widely used in cardiac surgery, and minimally invasive totally endoscopic mitral valve surgery has been developed as an alternative to median sternotomy for many patients with mitral valve disease. In this study, we describe our experience about a modified minimally invasive totally endoscopic mitral valve surgery and reported the preliminary results of totally endoscopic mitral valve surgery. The aim of this retrospective study is to evaluate the results of totally endoscopic technique in mitral valve surgery. Material and methods We retrospectively reviewed the profiles of 188 patients who were treated for mitral valve disease by modified totally endoscopic mitral valve surgery at our institution between January 2019 and December 2020. The procedure was performed under endoscopic right minithoracotomy and with femoro-femoral cannulation using the single two-stage venous cannula. Results A total of 188 patients underwent total endoscopic mitral valve surgery. Fifty-six patients had concomitant tricuspid valvuloplasty, 11 patients underwent concomitant ablation of atrial fibrillation and atrial septal defect repair was performed in three patients. Only one patient postoperatively died of multi-organ failure. Two patients were converted to median sternotomy. Except for one patient underwent operation to stop the bleeding from the incision site, no other serious complications nor reintervention occurred during the follow-up period. Conclusions The modified totally endoscopic mitral valve surgery performed at our institution is technically feasible and safe with the same efficacy as reported studies.

Minimally invasive (mini-thoracotomy) versus median sternotomy in redo mitral valve surgery: A meta-analysis of observational studies

2021 ◽  
pp. 021849232199708
Author(s):  
Azhar Hussain ◽  
Jacob Chacko ◽  
Mohsin Uzzaman ◽  
Osama Hamid ◽  
Salman Butt ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Length Of Stay ◽  
Minimally Invasive ◽  
Hospital Mortality ◽  
Observational Studies ◽  
Meta Analysis ◽  
Median Sternotomy ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Mini Thoracotomy

Objective Redo mitral valve surgery has traditionally been performed via a median sternotomy. It is often challenging and is associated with increased perioperative mortality. Advances in cardiac surgical techniques over the last two decades have led to an increase in the use of a minimally invasive approach via a right anterolateral mini-thoracotomy as opposed to a repeat median sternotomy. However, despite these advances, there is no general consensus on the best form of entry, and as of yet, there are no randomized controlled trials. We performed a meta-analysis of observational studies to aid in determining the best approach for redo mitral valve surgery. Method The MEDLINE and EMBASE databases were conducted up until 1 June 2020. Data regarding mortality, stroke, reoperation for bleeding and length of hospital stay, wound infection and cardiopulmonary bypass time were extracted and submitted to a meta-analysis using random effects modelling and the I2-test for heterogeneity. Seven retrospective observational studies were included, enrolling a total of 1070 patients. Results There were a total of 1070 patients. Of these 364 had non-sternotomy approach compared with 707 patients who had median sternotomy. Further subgroup analysis revealed that 327 of the 364 patients had a mini-thoracotomy approach while the remaining 37 patients had a full thoracotomy approach. In-hospital mortality and length of stay were less in non-sternotomy group compared to median sternotomy group. There were no differences in stroke, CPB time and wound infections between the two groups. Conclusion Redo mitral valve surgery can be performed safely with satisfactory outcomes via a mini-thoracotomy approach. This meta-analysis shows comparable results with reduced in-hospital mortality and hospital length of stay with a mini-thoracotomy approach.

scholarly journals Anterolateral minithoracotomy versus median sternotomy for mitral valve disease: a meta-analysis

2014 ◽  
Vol 15 (6) ◽  
pp. 522-532 ◽  
Author(s):  
Chao Ding ◽  
Da-ming Jiang ◽  
Kai-yu Tao ◽  
Qun-jun Duan ◽  
Jie Li ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Disease ◽  
Meta Analysis ◽  
Median Sternotomy ◽  
Valve Disease

scholarly journals Right Minithoraсotomy as a Standard Approach for Mitral Valve Surgery

2020 ◽  
pp. 23-28
Author(s):  
O. D. Babliak ◽  
V. M. Demianenko ◽  
D. Y. Babliak ◽  
A. I. Marchenko ◽  
K. A. Revenko ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Minimally Invasive ◽  
Mitral Valve Repair ◽  
Tricuspid Valve ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Standard Approach ◽  
Wound Complications ◽  
Tricuspid Valve Repair ◽  
Valve Repair

  Background. Minimally invasive mitral valve surgery provides many advantages for patients. The aim. To investigate and represent our own experience in minimally invasive mitral valve surgery, and to describe the operative technique. Materials and methods. The study was included 100 consecutive patients who underwent a minimally invasive mitral valve repair or replacement through the right lateral minithoracotomy from June 2017 to December 2019. Results. Mitral valve repair was performed in 87 patients (87%), and 13 patients (13%) were required mitral valve replacement. In 24 patients (24%), concomitant procedures were performed: tricuspid valve repair, atrial septal defect repair and left atrial myxomectomy. Ring anuloplasty was performed in all patients who underwent mitral valve repair. Additional methods of correction were used in accordance to the lesion anatomy: neochords implantation, cleft and leaflet perforation closure, leaflet resection, Alfieri (edge-to-edge) stitch, posterior leaflet plication. There was no in-hospital and 30-day mortality. Post-operative strokes were not reported. No wound complications were observed in the femoral cannulation area. The total length of stay in a hospital was 6 ± 1.46 (3–9) days. There were no cases of mitral valve insufficiency greater more than mild degree after mitral valve repair at the time of discharge. Conclusions. Minimally invasive mitral valve surgery can be performed as a routine standard approach, provides safe and effective correction of the mitral valve defects, allows excellent results of mitral valve repair and replacement in various abnormalities. Minimally invasive approach enables to perform a large number of reconstructive valve techniques and perform simultaneous correction of atrial septal defects, tricuspid valve repair and atrial neoplasm removal.

Surgical Management of Mitral Valve Disease

2015 ◽  
pp. 713-727
Author(s):  
Robin Varghese
Keyword(s):  
Mitral Valve ◽  
Surgical Management ◽  
Mitral Valve Disease ◽  
Surgical Techniques ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Valve Disease ◽  
Mitral Valve Stenosis ◽  
Complications Of Surgery ◽  
Future Direction

Surgery for the mitral valve has increased over the last decade, with a focus on an increasing number of valve repairs for degenerative mitral valve disease. This chapter discusses the surgical management of mitral valve disease with a focus on the pathology of mitral valve stenosis and regurgitation. With an examination into the pathophysiology of the lesions. Subsequently a discussion regarding the various surgical techniques for mitral valve surgery followed by the major and minor complications of surgery are reviewed to provide the Intensivist with an overview of possible complications. Finally a look at the future direction of the field is briefly examined.

Immediate Results of Mitral Valve Surgery in Asymptomatic Patients With Severe Mitral Regurgitation Due to Degenerative Mitral Valve Disease

Kardiologiia ◽  
2015 ◽  
Vol 11_2015 ◽  
pp. 53-60
Author(s):  
V.M. Nazarov Nazarov ◽  
A.V. Afanasyev Afanasyev ◽  
S.I. Zheleznev Zheleznev ◽  
A.V. Bogachev-Prokophiev Bogachev-Prokophiev ◽  
I.I. Demin Demin ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Disease ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Valve Disease ◽  
Severe Mitral Regurgitation ◽  
Asymptomatic Patients

scholarly journals Mitral Valve Surgery for Primary or Secondary Mitral Valve Disease: 8-Year Comparative Cohort Study

2019 ◽  
Vol 28 ◽  
pp. S14
Author(s):  
Tom Kai Ming Wang ◽  
Yi-Wen (Becky) Liao ◽  
David Choi ◽  
Tharumenthiran Ramanathan ◽  
Ivor Gerber
Keyword(s):  
Cohort Study ◽  
Mitral Valve ◽  
Mitral Valve Disease ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Valve Disease ◽  
Comparative Cohort Study

scholarly journals Transthoracic clamp versus endoaortic balloon occlusion in minimally invasive mitral valve surgery: a systematic review and meta-analysis

2019 ◽  
Vol 56 (4) ◽  
pp. 643-653 ◽  
Author(s):  
Paul Martin Rival ◽  
Theresa H M Moore ◽  
Alexandra McAleenan ◽  
Hamish Hamilton ◽  
Zachary Du Toit ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mitral Valve ◽  
Minimally Invasive ◽  
Cerebrovascular Accident ◽  
Meta Analysis ◽  
Mitral Valve Surgery ◽  
Balloon Occlusion ◽  
Valve Surgery ◽  
Risk Of Bias ◽  
Aortic Cannulation

Summary This systematic review and meta-analysis aims to determine outcomes following aortic occlusion with the transthoracic clamp (TTC) versus endoaortic balloon occlusion (EABO) in patients undergoing minimally invasive mitral valve surgery. A subgroup analysis compares TTC to EABO with femoral cannulation separately from EABO with aortic cannulation. We searched Medline and Embase up to December 2018. Two people independently and in duplicate screened title and abstracts, full-text reports, extracted data and assessed the risk of bias using the Cochrane risk-of-bias tool for non-randomized studies. We identified 1564 reports from which 11 observational studies with 4181 participants met the inclusion criteria. We found no evidence of difference in the risk of postoperative death or cerebrovascular accident (CVA) between the 2 techniques. Evidence for a reduction in aortic dissection with TTC was found: 4 of 1590 for the TTC group vs 19 of 2492 for the EABO group [risk ratio 0.33, 95% confidence interval (CI) 0.12–0.93; P = 0.04]. There was no difference in aortic cross-clamp (AoX) time between TTC and EABO [mean difference (MD) −5.17 min, 95% CI −12.40 to 2.06; P = 0.16]. TTC was associated with a shorter AoX time compared to EABO with femoral cannulation (MD −9.26 min, 95% CI −17.00 to −1.52; P = 0.02). EABO with aortic cannulation was associated with a shorter AoX time compared to TTC (MD 7.77 min, 95% CI 3.29–12.26; P < 0.001). There was no difference in cardiopulmonary bypass (CPB) time between TTC and EABO with aortic cannulation (MD −4.98 min, 95% CI −14.41 to 4.45; P = 0.3). TTC was associated with a shorter CPB time compared to EABO with femoral cannulation (MD −10.08 min, 95% CI −19.93 to −0.22; P = 0.05). Despite a higher risk of aortic dissection with EABO, the rates of survival and cerebrovascular accident across the 2 techniques are similar in minimally invasive mitral valve surgery.

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