Pass On What You Have Learned: A Structured Mentor-Mentee Concept for the Implementation of a Minimally Invasive Mitral Valve Surgery Program

2021 ◽  
pp. 1-7
Author(s):  
Christian Heim ◽  
Philipp P. Müller ◽  
Parwis Massoudy ◽  
Frank Harig ◽  
Ehab Nooh ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Minimally Invasive ◽  
Low Cost ◽  
Mitral Valve Surgery ◽  
Ring Annuloplasty ◽  
Cardiac Surgeon ◽  
Heart Center ◽  
Cardiac Surgeons ◽  
Dedicated Team

<b><i>Introduction:</i></b> Starting a minimally invasive cardiac surgery (MICS) for mitral valve repair (MVR) program is challenging as it requires a new learning curve, but compromising surgical results at the same time is not acceptable. Here, we describe our surgical educational experience of starting a new MICS program at a university heart center in Germany. <b><i>Methods:</i></b> A dedicated team for the new MICS program including 2 cardiac surgeons, 1 cardiac anesthetist, 1 perfusionist, and 1 scrub nurse was chosen. The use of long shafted instruments was trained in a low-cost self-assembled MICS simulator, and the EACTS endoscopic dry lab course was visited. Thereafter, 1 MICS center was visited for direct observation and peer-to-peer education for 6 weeks. The mentor observed the first 10 cases performed by the mentee. The surgical mitral valve expertise of 1 single cardiac surgeon was retrospectively analyzed between April 2016 and April 2021. <b><i>Results:</i></b> Before the implementation of the MICS-MVR program, 18 mitral valve operations have been performed through sternotomy between April 2016 and October 2018 including 12 replacements and 6 ring annuloplasties. After starting the MICS-MVR program, 73 mitral operations have been performed by the same surgeon of which 53 video-assisted through minithoracotomy (72.6%). 83.1% of the MICS procedures included complex repair (<i>n</i> = 38) and ring annuloplasty (<i>n</i> = 6). Open heart MV surgery was necessary in 20 patients due to concomitant procedures (<i>n</i> = 8), redo procedures (<i>n</i> = 2), severe endocarditis (<i>n</i> = 4), or contraindication for MICS such as PAD (<i>n</i> = 6). There have been no deaths, 1 stroke, and 1 cardiac vascular (RCX) complication. Two patients required conversion to sternotomy and one pericardiocentesis in the long term. <b><i>Conclusion:</i></b> Typically, excellent exposure and high repair rates of the MV has led us offer MICS approach to a majority of patients with isolated MV disease. Careful planning and a strict mentor-mentee concept facilitated a safe startup of an MICS program in a busy university heart center.

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.

Minimally Invasive Mitral Valve Surgery in Truly High-Risk Patients: Are We Pushing the Boundaries? An Observational Study

2015 ◽  
Vol 10 (5) ◽  
pp. 328-333 ◽  
Author(s):  
Marco Moscarelli ◽  
Rafik Margaryan ◽  
Alfredo Cerillo ◽  
Enkel Kallushi ◽  
Pierandrea Farneti ◽  
...  
Keyword(s):  
High Risk ◽  
Mitral Valve ◽  
Minimally Invasive ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Tricuspid Valve Repair ◽  
Discrimination Power ◽  
High Risk Patients ◽  
Risk Patients

Objective This study aimed to assess in a retrospective series of truly high-risk patients who underwent minimally invasive mitral valve surgery: (1) postoperative and long-term results and (2) logistic EuroSCORE and EuroSCORE II discrimination power. Methods Between 2003 and 2013, we reviewed in our institution patients who underwent minimally invasive mitral valve surgery with or without tricuspid valve repair via right minithoracotomy with logistic EuroSCORE of 20 or higher. Results Among a total number of 1604, 88 patients were identified. Median logistic and EuroSCORE II was 27.29 (interquartile range, 15.3) and 12.7% (11.3%), respectively. Mean (SD) age was 71.9 (8.4) years; 42 were female (47.7%); 60 patients (68.1%) underwent previous sternotomy. Mitral valve was replaced in 59 (67%) and repaired in 29 (32.9%) patients; tricuspid valve repair was performed in 23 patients (26.1%). Median cardiopulmonary bypass and cross-clamp times were 157 minutes (interquartile range, 131–187 minutes) and 83 minutes (81–116 minutes), respectively; conversion to sternotomy and reopening for bleeding was necessary in 4 (4.5%) and 3 (3.4%) patients; permanent and transient neurological injuries were reported in 6 (6.8%) and 3 (3.4%) patients; acute kidney injury was reported in 13 patients (14.7%); 15 patients (17%) had pulmonary complications. Ten patients died while in the hospital (11.2%). Survival at 6 years was 78% (95% confidence interval, 69–88). Conclusions In this series of truly high-risk patients, minimally invasive mitral surgery was associated with acceptable early mortality and morbidity as well as long-term outcomes; both logistic and EuroSCORE II showed suboptimal discrimination power.

scholarly journals Long-term results after mitral valve surgery using minimally invasive versus sternotomy approach: a propensity matched comparison of a large single-center series

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ayse Cetinkaya ◽  
Anna Geier ◽  
Karin Bramlage ◽  
Stefan Hein ◽  
Peter Bramlage ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Minimally Invasive ◽  
Length Of Hospital Stay ◽  
Cardiovascular Death ◽  
Mitral Valve Surgery ◽  
Long Term Results ◽  
Term Survival ◽  
The Difference ◽  
Matched Comparison

Abstract Background Mitral valve (MV) surgery has traditionally been performed by conventional sternotomy (CS), but more recently minimally invasive surgery (MIS) has become another treatment option. The aim of this study is to compare short- and long-term results of MV surgery after CS and MIS. Methods This study was a retrospective propensity-matched analysis of MV operations between January 2005 and December 2015. Results Among 1357 patients, 496 underwent CS and 861 MIS. Matching resulted in 422 patients per group. The procedure time was longer with MIS than CS (192 vs. 185 min; p = 0.002) as was cardiopulmonary bypass time (133 vs. 101 min; p < 0.001) and X-clamp time (80 vs. 71 min; p < 0.001). ‘Short-term’ successful valve repair was higher with MIS (96.0% vs. 76.0%, p < 0.001). Length of hospital stay was shorter in MIS than CS patients (10 vs. 11 days; p = 0.001). There was no difference in the overall 30-day mortality rate. Cardiovascular death was lower after MIS (1.2%) compared with CS (3.8%; OR 0.30; 95%CI 0.11–0.84). The difference did not remain significant after adjustment for procedural differences (aOR 0.40; 95%CI 0.13–1.25). Pacemaker was required less often after MIS (3.3%) than CS (11.2%; aOR 0.31; 95%CI 0.16–0.61), and acute renal failure was less common (2.1% vs. 11.9%; aOR 0.22; 95%CI 0.10–0.48). There were no significant differences with respect to rates of stroke, myocardial infarction or repeat MV surgery. The 7-year survival rate was significantly better after MIS (88.5%) than CS (74.8%; aHR 0.44, 95%CI 0.31–0.64). Conclusion This study demonstrates that good results for MV surgery can be obtained with MIS, achieving a high MV repair rate, low peri-procedural morbidity and mortality, and improved long-term survival.

scholarly journals 1. Glauber, M., et al., Early and long-term outcomes of minimally invasive mitral valve surgery through right minithoracotomy: a 10-year experience in 1604 patients. J Cardiothorac Surg, 2015. 10: p. 181. 2. Gammie, J.S., et al., J. Maxwell Chamberl

2020 ◽  
Vol 26 ◽  
pp. 52-60
Author(s):  
Vo Tuan Anh ◽  
Nguyen Thi Thu Trang ◽  
Pham Tran Viet Chuong ◽  
Vu Tam Thien ◽  
Nguyen Hoang Dinh
Keyword(s):  
Mitral Valve ◽  
Minimally Invasive ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Long Term Outcomes

Hồi cứu mô tả loạt ca các bệnh nhân được phẫu thuật van hai lá ít xâm lấn qua đường mở ngực phải nhỏ có nội soi lồng ngực hỗ trợ tại bệnh viện Đại học Y Dược Thành phố Hồ Chí Minh  từ  tháng  8/2014  đến  tháng  8/2018.  Có 183 trường hợp phẫu thuật van hai lá, trong đó có 86trường hợp sửa van, tuổi trung bình 50.1 ±12.6 tuổi. Tỷ lệ nam/nữ là 1.2:1. Trong đó có 76 trường hợp van thoái hóa, 1 trường hợp van hậu thấp, 2 trường hợp viêm nội tâm mạc nhiễm trùng, 3 trường hợp tổn thương mép van và 4 trường hợp tim bẩm sinh. Cơ chế tổn thương chính là sa lá sau (59 trường hợp), đứng thứ hai là sa lá trước với 17 trường hợp, sa cả lá trước và lá  sau có 5 trường hợp và chẻ lá van chiếm 4 trường hợp phẫu thuật, 1 trường hợp có giới hạn lá van. 15 trường hợp có biến chứngtrong đó, tràn máu màng ngoài phổi cần dẫn lưu có 4 trường  hợp,  1  trường  hợp  vỡ  vòng  van,  1 trường hợp mổ lại do hở tồn lưu và 9 trường hợp mổ lại do chảy máu, 1 trường hợp hẹp động mạch đùi phải cần mổ lại. Không có tử vong. Tỉ lệ sửa van hai lá thành công (không hở hoặc hở độ 1 trên siêu âm sau mổ) cao (93%).

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