Clinical Results of Minimally Invasive Mitral Valve Surgery

2009 ◽  
Vol 4 (6) ◽  
pp. 311-318 ◽  
Author(s):  
Fabio Ius ◽  
Enzo Mazzaro ◽  
Vincenzo Tursi ◽  
Giorgio Guzzi ◽  
Enrico Spagna ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Minimally Invasive ◽  
Heart Association ◽  
Clinical Results ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Actuarial Survival ◽  
Significant Difference ◽  
Group A ◽  
Group B

Objective This study was carried out with the aim of presenting our experience with minimally invasive mitral surgery and compare the endoaortic clamp with the external aortic clamp (EAC) techniques. Methods Between December 2002 and May 2009, 139 patients (75 men, aged 63 ± 11 years) underwent video-assisted mitral valve surgery through right thoracotomy. Twelve (9%) patients were operated without clamping the aorta, 32 (23%) patients (group A) were operated on by using the endoaortic clamp, and 95 (68%) patients were operated on by using the EAC (group B). There was no significant difference between groups A and B regarding preoperative variables. Results Intraoperative procedure-associated problems were experienced in three group A patients (9.3%, two aortic dissections with conversion to sternotomy; one conversion due to bad exposure) and in two group B patients (2%, one conversion to sternotomy for bleeding and one for ascending aorta hematoma). At a mean follow-up of 32 months, 121 patients (97%) were in New York Heart Association class I–II, with satisfactory echocardiographic results. There was one in-hospital and six late deaths (three noncardiac, two cardiac, and one valve related). Five-year actuarial survival was 88% ± 8%. There were three reoperations, one early (<30 days) after complex mitral valve repair, with a 5-year freedom from reoperation of 97% ± 2%. Postoperative levels of myocardial cytonecrosis enzymes as well as the extracorporeal circulation time were significantly lower in group B patients (P < 0.05). Conclusions Intraoperative procedure-associated complications with endoclamping combined with an apparently better myocardial protection forced us to change our practice to the more simple and economic EAC technique.

scholarly journals Video-assisted Minimally Invasive Mitral Valve Surgery versus Conventional Mitral Surgery in Rheumatic Patients

2020 ◽  
Author(s):  
Ayman Badawy ◽  
Mohamed Alaa Nady ◽  
Mohamed Ahmed Khalil Salama Ayyad ◽  
Ahmed Elminshawy
Keyword(s):  
Mitral Valve ◽  
Minimally Invasive ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Invasive Approach ◽  
Video Assisted ◽  
Group A ◽  
Group B

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.

Video-Assisted Minimally Invasive Mitral Valve Surgery External Aortic Clamp versus Endoclamp Techniques

2010 ◽  
Vol 5 (6) ◽  
pp. 413-418 ◽  
Author(s):  
Antonio Loforte ◽  
Giampaolo Luzi ◽  
Andrea Montalto ◽  
Federico Ranocchi ◽  
Vincenzo Polizzi ◽  
...  
Keyword(s):  
New York ◽  
Mitral Valve ◽  
Heart Association ◽  
Mitral Valve Surgery ◽  
Balloon Occlusion ◽  
Valve Surgery ◽  
Aortic Clamping ◽  
Video Assisted ◽  
Group A ◽  
Group B

Objective Video-assisted minimally invasive mitral valve surgery can be performed through different approaches. The aim of the study was to report our early results and compare the external transthoracic aortic clamping with the endoaortic balloon occlusion techniques according to our experience. Methods Between January 2000 and March 2010, 138 patients (103 women, aged 58.4 ± 10.2 years) underwent video-assisted mitral valve surgery through a right thoracotomy. Cardiopulmonary bypass was instituted by femoral arterial and bicaval cannulation with active venous drainage and normothermia; cardioplegic arrest achieved with intermittent blood cardioplegia. In group A (93 patients, 68 women, aged 58.8 ± 7.8 years, 72 MV replacement, 21 MV repair), aortic clamping was achieved using the external transthoracic aortic clamp. In group B (45 patients, 35 women, aged 58.1 ± 11.4 years, 33 MV replacement, 12 MV repair), aortic clamping was achieved with endoaortic balloon occlusion. Results Intraoperative procedure-associated problems were experienced in one patient (0.7%) in group A (one conversion to sternotomy for pleural adhesions and bad exposure). At a mean follow-up of 36 ± 18 months, 135 patients (97.8%) were in New York Heart Association class I to II, with satisfactory echocardiographic follow-up. In group A, two patients had noncardiac-related deaths. No perioperative deaths were observed in both groups. There were four (2.8%) transient ischemic attacks and one (0.7%) peripheral ischemic event (group A) during the early postoperative period. Mitral valve repair patients had a 5-year freedom from reoperation of 100% in both groups. There was no significant difference between the two groups regarding preoperative variables, such as age, sex, New York Heart Association class, and left ventricular ejection fraction (P ≥ 0.05). Postoperative levels of myocardial cytonecrosis enzymes (MB fraction, creatine kinase, and troponine I) as well as operative time, extracorporeal circulation, and aortic cross-clamping times or ventilation and intensive care unit times were not significantly different between the two groups (P ≥ 0.05). More microembolic events were observed in group A than in group B (total 143.4 ± 30.6 per patient vs 78.9 ± 28.6 per patient) by means of continuous automated intraoperative transcranial Doppler evaluations (P < 0.05) applied to part of population. Conclusions Both techniques proved safe and comparable with low risk of morbidity and mortality. Patients undergoing endoclamp technique resulted to be less subject to embolism.

scholarly journals A Simple Approach for Minimally Invasive Combined Aortic and Mitral Valve Surgery

2021 ◽  
Author(s):  
Hesham Alkady ◽  
Sobhy Abouramadan
Keyword(s):  
Mechanical Ventilation ◽  
Mitral Valve ◽  
Minimally Invasive ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
P Value ◽  
Group A ◽  
The Mean ◽  
Mechanical Ventilation Time ◽  
Group B

Abstract Background There is now extension of minimally invasive techniques to involve concomitantly aortic and mitral valves through a single small incision. We share our experience in such surgeries through upper partial sternotomy with approaching the mitral valve through the dome of the left atrium. Methods Two matched groups of cases receiving concomitant aortic and mitral valve surgeries are compared regarding the surgical outcomes: the minimally invasive group (group A) including 72 patients and the conventional group (group B) including 78 patients. Results The mean age was 52 ± 8 years in group A and 53 ± 7 years in group B. Males represented (42%) in group A and (49%) in group B. The mean mechanical ventilation time was significantly shorter in group A (4.3 ± 1.2 hours) than in group B (6.1 ± 0.8 hours) with a p-value of 0.001. In addition, the amount of chest tube drainage and the need for blood transfusion units were significantly less in group A (250 ± 160 cm3 and 1.3 ± 0.8 units, respectively) when compared with group B (320 ± 180 cm3 and 1.8 ± 0.9 units, respectively) with p-values of 0.013 and 0.005, respectively. Over a follow-up period of 3.2 ± 1.1 years, one mortality occurred in each group with no significant difference (p-value = 0.512). Conclusion Combined aortic and mitral valve surgery through upper partial sternotomy with approaching the mitral valve through the dome of the left atrium is safe and effective with the advantages of less postoperative blood loss, need for blood transfusion, and mechanical ventilation time compared with conventional aortic and mitral valve surgery.

Is obesity associated with poorer outcomes in patients undergoing minimally invasive mitral valve surgery?

2020 ◽  
Vol 59 (1) ◽  
pp. 187-191 ◽  
Author(s):  
Firas Aljanadi ◽  
Caroline Toolan ◽  
Thomas Theologou ◽  
Matthew Shaw ◽  
Kenneth Palmer ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Minimally Invasive ◽  
High Body Mass Index ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
World Health ◽  
Obese Patients ◽  
Operative Outcomes ◽  
Significant Difference ◽  
Baseline Characteristics

Abstract OBJECTIVES High body mass index (BMI) makes minimally invasive mitral valve surgery (MIMVS) more challenging with some surgeons considering this a contraindication. We sought to determine whether this is because the outcomes are genuinely worse than those of non-obese patients. METHODS This is a retrospective cohort study of all patients undergoing MIMVS ± concomitant procedures over an 8-year period. Patients were stratified into 2 groups: BMI ≥ 30 kg/m2 and BMI ˂ 30 kg/m2, as per World Health Organization definitions. Baseline characteristics, operative and postoperative outcomes and 5-year survival were compared. RESULTS We identified 296 patients (BMI ≥30, n = 41, median 35.3, range 30–43.6; BMI &lt;30, n = 255, median 26.2, range 17.6–29.9). The groups were well matched with regard to baseline characteristics. There was only 1 in-hospital mortality, and this was in the BMI &lt; 30 group. There was no difference in repair rate for degenerative disease (100% vs 96.3%, P &gt; 0.99 respectively) or operative durations [cross-clamp: 122 min interquartile range (IQR) 100–141) vs 125 min (IQR 105–146), P = 0.72, respectively]. There were only 6 conversions to sternotomy, all in non-obese patients. There was no significant difference in any other perioperative or post-operative outcomes. Using the Kaplan–Meier analysis, there was no significant difference in 5-year survival between the 2 groups (95.8% vs 95.5%, P = 0.83, respectively). CONCLUSIONS In patients having MIMVS, there is insufficient evidence to suggest that obesity affects either short- or mid-term outcomes. Obesity should therefore not be considered as a contraindication to this technique for experienced teams.

scholarly journals Design and training effects of a physical reality simulator for minimally invasive mitral valve surgery

2019 ◽  
Vol 29 (3) ◽  
pp. 409-415 ◽  
Author(s):  
Ahmad-Fawad Jebran ◽  
Shekhar Saha ◽  
Narges Waezi ◽  
Ammar Al-Ahmad ◽  
Heidi Niehaus ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Minimally Invasive ◽  
Mitral Valve Surgery ◽  
Learning Curves ◽  
Valve Surgery ◽  
Training Effects ◽  
Training Course ◽  
Skill Scores ◽  
Significant Difference

Abstract OBJECTIVES Minimally invasive mitral valve surgery (MIMVS) through an endoscopic right minithoracotomy is a well-established yet complex procedure that has a challenging learning curve. We have developed a simulator for MIMVS and evaluated its short- and long-term training effects. METHODS Trainees without simulator experience or training in MIMVS were divided into 2 groups (10 students and 10 residents) and participated in a 5-day training course after initial instruction. Each trainee performed a ring annuloplasty. Scores were given by a supervisor who assessed 5 skills. The duration of each procedure was also measured. To evaluate the long-term effect of the training course, trainees performed the same procedure 4 weeks after the last session. RESULTS Trainees in the resident group were significantly older compared to those in the student group and had a mean surgical experience of 4.4 ± 0.78 years standard error of the mean. All other demographic data were similar. Significant learning curves could be achieved in both groups over the course of 5 days with regard to total skill scores and total duration. However, when we compared the learning curves of both groups, no significant difference could be seen. Long-term performance in both groups was still significantly better compared to that in the first training session. CONCLUSIONS Training with our simulator provided a significant enhancement of a trainee’s performance. This learning effect was achieved in both groups and was still evident 4 weeks later. We strongly recommend our simulator for simulation-based surgical education of cardiac surgeons interested in MIMVS.

scholarly journals Surgical Repair versus Conservative Treatment for Moderate Functional Tricuspid Regurgitation in Concomitant with Mitral Valve Surgery

2020 ◽  
Vol 2 (2) ◽  
pp. 70-75
Author(s):  
Moataz Rezk ◽  
Shimaa Moustafa ◽  
Nora Singab ◽  
Ashraf Elnahas
Keyword(s):  
Mitral Valve ◽  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Surgical Repair ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Functional Tricuspid Regurgitation ◽  
Group A ◽  
Group B ◽  
Valve Lesion

Background: Management of moderate functional tricuspid regurgitation (FTR) secondary to left-sided valve lesion is controversial. The objective of this study was to compare the short-term results of surgical repair versus conservative treatment for moderate functional tricuspid regurgitation in concomitant with mitral valve surgery. Methods: Our study included 60 patients with mitral valve lesion and moderate functional tricuspid regurgitation. Patients were divided into 2 groups; group A included 30 patients whose tricuspid valve disease were managed conservatively, and group B included 30 patients who had tricuspid valve band annuloplasty. Results: Preoperative clinical and echocardiographic data were comparable between groups. There was no difference regarding mechanical ventilation time (6 .13 ± 3.02 vs. 7.01 ± 4.14 hours; p= 0.291), or intensive care unit stay (51.42 ± 12.1 vs. 52.31 ± 15.32 hours; p=0.614) in group A and B respectively. There was a significant improvement in the degree of tricuspid valve regurgitation in group B early postoperative (moderate tricuspid regurgitation reported in 22 (73.3%) vs. 4 (13.3%); p<0.001) and at 3 months (moderate tricuspid regurgitation 11 (36.7%) vs. 2 (6.7%); p<0.001) and 6 months follow up (moderate tricuspid regurgitation 10 (30%) vs.  2 (6.7%); p<0.001) in group A and B respectively. After 6-months, 20 (66.7%) patients in group A had dyspnea grade I compared to 26 (86.7%) patients in group B; p=0.021. Conclusion: Although the correction of the left-sided lesion improved the degree of TR in some patients, concomitant repair of the tricuspid valve could produce better improvement in the clinical outcome when compared to the conservative approach.

scholarly journals Minimally Invasive versus Conventional Mitral Valve Surgery Comparison of Early Outcomes

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
M A Mohamed ◽  
T M Elsayegh ◽  
H Y Elbawab ◽  
Y M Elnahas ◽  
A H Omar
Keyword(s):  
Mitral Valve ◽  
Minimally Invasive ◽  
Median Sternotomy ◽  
Operation Time ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Safe Alternative ◽  
Invasive Group ◽  
Significant Difference ◽  
The Right

Abstract The mitral valve has been traditionally approached through a median sternotomy. However, mitral valve surgery could be performed using smaller incisions including the right minithoracotomy. This study was a case-control non randomized conducted on 60 patients. All patients had isolated mitral valve disease for mitral valve surgery, 30 of them were operated through right anterolateral minithoracotomy and the others through full median sternotomy to study the effects of minimally invasive mitral valve surgery through right anterolateral minithoracotomy on morbidity and mortality compared with conventional mitral surgery. Medico legal concent was taken from all the patients in this study. All the patients completed the study and there was no mortality among the patients. There was no statistically significant difference as regards the demograohic data, NYHA score and the preoperative echocardiographic findings. Regarding intraoperative comparison, there was statistically significant difference in the cross-clamp time, total bypass time & total operation time. This difference may be due to the new experiences in this MIMVS and the lack of instrumentation that narrow the field of MIMVS. The length of the incision was highly significantly lesser in the minimally invasive group than the full sternotomy group. There was significant difference in the intensive care parameters. The blood loss and the blood transfusion required were lesser in the minimally invasive group. But the ventilation hours and ICU stay was nearly the same in both groups. There was highly significantly less postoperative pain in the minimally invasive group than in the stenotomy group. Total hospital stay was nearly the same in both groups. Minimally invasive mitral valve surgery is a safe alternative to a conventional approach and is associated with less morbidity especially with expert surgeon in simple mitral valve surgery.

Clinical Results of Minimally Invasive Mitral Valve Surgery

2009 ◽  
Vol 4 (6) ◽  
pp. 311-318 ◽  
Author(s):  
Fabio Ius ◽  
Enzo Mazzaro ◽  
Vincenzo Tursi ◽  
Giorgio Guzzi ◽  
Enrico Spagna ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Minimally Invasive ◽  
Clinical Results ◽  
Mitral Valve Surgery ◽  
Valve Surgery
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