Early outcomes of mitral valvuloplasty by minimally invasive surgery or sternotomy

Background Disagreement exists regarding methods for repair of the mitral valve. We compared early outcomes of mitral valvuloplasty by a minimally invasive technique and by a median sternotomy. Methods The data of 507 patients (mean age 47.9 ± 15.2 years) undergoing mitral valvuloplasty from January 2015 to June 2018 were analyzed retrospectively. In the study group ( n = 225), mitral valvuloplasty via a totally thoracoscopic approach was performed by a single surgeon. In the control group ( n = 282), mitral valvuloplasty via the traditional median sternotomy was carried out by other cardiac surgeons in our hospital. Clinical data, surgical results, and follow-up findings in the two groups were comparatively analyzed. Results In the study group, the blood transfusion rate (5.3% vs. 20.9%, p < 0.05) and incidences of poor wound healing (0 vs. 5.3%, p < 0.05) and respiratory tract infection (4.4% vs. 16.3%, p < 0.05) were lower, and postoperative hospitalization was shorter (5.9 ± 4.0 vs. 10.7 ± 8.4 days, p < 0.05). Within 30 days after surgery, no patient died in the study group while one died in the control group. The duration of follow-up was 12–36 months (mean 22.9 ± 8.8 months). During follow-up, there were 1 and 0 cases of redo surgery and 1 and 3 deaths in the study group and control group, respectively. Conclusion Mitral valvuloplasty via a minimally invasive approach is superior to the traditional median sternotomy in terms of early outcomes, especially when performed by experienced surgeons.

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Uni-port total thoracoscopic surgery versus median sternotomy for redo tricuspid valve replacement: A retrospective study

10.21203/rs.3.rs-17615/v1 ◽

2020 ◽

Author(s):

Licheng Yan ◽

Fuzhen Zheng ◽

Haiyu Chen ◽

Jiayin Bao ◽

Guoxing Weng

Keyword(s):

Valve Replacement ◽

Tricuspid Valve ◽

Thoracoscopic Surgery ◽

Median Sternotomy ◽

Control Group ◽

Study Group ◽

Valve Regurgitation ◽

Tricuspid Valve Replacement ◽

Tricuspid Valve Regurgitation

Abstract BACKGROUNDː This study compared the perioperative and follow-up period data of patients who underwent redo tricuspid valve replacements performed via thoracoscopic surgery or median sternotomy. The purpose was to evaluate the feasibility, safety, and surgical outcomes of redo tricuspid valve replacement via uni-port thoracoscopic surgery. METHODSː Forty-nine patients with severe tricuspid valve regurgitation after left-side valve replacement underwent redo tricuspid valve replacements in our hospital from April 2012 to September 2019. 26 patients underwent uni-port total thoracoscopy surgery, whereas 23 patients had the surgery performed via median sternotomy. We collected perioperative and 3- to 36-month postoperative data. RESULTSː No deaths occurred in the intraoperative period. Time of cardiopulmonary bypass in the study group was significantly longer than that in the control group (P<0.05), but the operative times in the study and control groups were not significantly different. Thoracic drainage, length of ICU stay, postoperative hospital stay and complication rates in the study group were significantly different from those in the control group (P<0.05). Throughout the follow-up period, uni-port total thoracoscopic TVR is not inferior to traditional surgery with respect to cardiac function and recurrence of tricuspid valve regurgitation. CONCLUSIONSː Uni-port total thoracoscopic tricuspid valve replacement is safe, feasible and effective, and that can be considered as a primary treatment strategy for patients with severe TR after previous left-sided valve procedure.

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The double tunnels technique: an alternative minimally invasive approach for carpal tunnel syndrome

Journal of Neurosurgery ◽

10.3171/2014.11.jns14901 ◽

2015 ◽

Vol 123 (5) ◽

pp. 1230-1237 ◽

Cited By ~ 4

Author(s):

Daniele Vanni ◽

Francesco Saverio Sirabella ◽

Renato Galzio ◽

Vincenzo Salini ◽

Vincenzo Magliani

Keyword(s):

Carpal Tunnel Syndrome ◽

Minimally Invasive ◽

Carpal Tunnel ◽

Secondary Outcome ◽

Invasive Technique ◽

Control Group ◽

P Value ◽

Invasive Approach ◽

Group A ◽

Tunnel Syndrome

OBJECT The purpose of this study was to assess the effectiveness and safety of an alternative minimally invasive technique for the treatment of carpal tunnel syndrome (CTS). METHODS This was designed as a prospective, randomized, open-label, blinded end point evaluation (PROBE) study. The active comparison was double tunnels technique (DTT) (Group A, 110 patients) versus standard open decompression of the median nerve (control [Group B], 110 patients). Patient recruitment started in January 2011. The primary outcomes were the functional Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ) scores and visual analog scale (VAS) scores for pain (pVAS) at Weeks 2 and 4, and at Months 3, 6, and 12. The secondary outcome was the aesthetics (aVAS) score at Weeks 2 and 4, and at Months 3, 6, and 12. RESULTS The Student t-test and ANOVA were used, and the results were considered statistically significant if the p value was ≤ 0.05 for continuous variables. The DTT is a tissue-sparing approach that allows the surgeon to limit the length of the incision (0.6 ± 0.05 cm) and to respect the palmar fascia and the subcutaneous tissue. Recovery from wrist pain, night pain, numbness, stiffness, and weakness was achieved more effectively and quickly compared with the standard approach. Better BCTSQ, pVAS, and aVAS scores were observed in Group A. CONCLUSIONS The DTT is a safe and effective approach for the treatment of CTS. This technique entails faster recovery times, better aesthetic outcomes, and lower risks of complications.

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Distal Chevron Osteotomy vs The Simple, Effective, Rapid, Inexpensive Technique (SERI) for Mild to Moderate Isolated Hallux Valgus: A Randomized Controlled Study

10.21203/rs.3.rs-17170/v1 ◽

2020 ◽

Author(s):

Ezequiel Palmanovich ◽

Nissiom Ohana* - equal first author contribution ◽

Ilan Small ◽

Iftach Hetsroni ◽

Eyal Amar ◽

...

Keyword(s):

Minimally Invasive ◽

Hallux Valgus ◽

Controlled Study ◽

Wound Complications ◽

Invasive Technique ◽

Control Group ◽

Chevron Osteotomy ◽

The Mean ◽

One Year

Abstract Background Hallux valgus is a common foot deformity that leads to functional disability with serious sequelae. Minimally invasive surgery is often used to treat hallux valgus in order to reduce wound complications and improve recovery time. The objective of this study was to compare a Simple, Effective, Rapid, Inexpensive (SERI) technique with a simple Chevron technique in patients with minimum of one-year follow. Methods and Materials Between the years 2014-2015 we performed a prospective study comparing the SERI minimally invasive technique to treat symptomatic hallux valgus with a standard chevron osteotomy technique. All procedures were performed by a single fellowship trained foot and ankle surgeon. Twenty-one patients were randomized to the SERI cohort and 15 to the standard Chevron technique. Results The mean pre-operative intermetatarsal angle (IMA) of the SERI group was 14.8 ± 1.9 (11.9 - 22.9). The mean pre-operative IMA of the Chevron control group was 13.3 ± 2.3 (10.4 -18.2) (p = 0.038). The mean IMA two weeks after surgery was 6.0 ± 2.3 (2.4-12) in the SERI group, and 6.1 ± 3 (2.6-13.1) in the control group. At the two week and one year follow up, there was no significant difference found in the IMA between the two groups (p = 0.871). Neither groups reported symptomatic transfer metatarsalgia throughout the follow up period. The SERI group had increased metatarsophalangeal joint (MTPJ) motion (p < 0.001) however, all other parameters with similar. Conclusion The SERI technique provided comparable outcomes at up to one year follow up when compared to a standard Chevron osteotomy for moderate hallux valgus. This study demonstrated good reproducible results using the SERI technique for moderate hallux valgus.

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Translaminar Osseous Channel–Assisted FullEndoscopic Flavectomy Decompression of Thoracic Myelopathy Caused by Ossification of the Ligamentum Flavum: Surgical Technique and Results

January 2018 - Pain Physician ◽

10.36076/ppj.2020/23/e475 ◽

2020 ◽

Vol 5;23 (9;5) ◽

pp. E475-E485

Author(s):

Wenbo Liao

Keyword(s):

Minimally Invasive ◽

Study Design ◽

Spine Surgery ◽

Ligamentum Flavum ◽

Japanese Orthopaedic Association ◽

Invasive Technique ◽

Control Group ◽

Thoracic Myelopathy ◽

Radiographic Findings

Background: Previous surgical procedures for the treatment of thoracic myelopathy (TM) due to ossification of the ligamentum flavum (OLF) were accompanied by significant trauma and risk. Objectives: Report a novel minimally invasive technique, translaminar osseous channel–assisted posterior percutaneous full-endoscopic flavectomy (p-PEF), as an alternative surgical strategy for the treatment of OLF-related TM. Study Design: A retrospective cohort study. Setting: A center for spine surgery and pain medicine. Methods: Thirteen patients with TM caused by isolated OLF who underwent translaminar osseous channel–assisted p-PEF were retrospectively analyzed. Preoperative and postoperative radiographic findings and clinical results were compared to confirm the efficacy of the procedure and perioperative complications were investigated to evaluate the technical safety. Results: All 13 patients with 23 isolated ossified sites were successfully treated with the translaminar osseous channel–assisted p-PEF technique and no additional internal fixation was needed. With an average follow-up of 29.2 months (range, 24–36 months), no local instability was detected. The preoperative and final follow-up cross-sectional area of the stenotic dural sac was 47.87 ± 8.98 mm2 and 130.47± 19.07 mm2 , respectively (P < 0.0001). The mean modified Japanese Orthopaedic Association score was significantly improved from 3.54 ± 1.26 points preoperatively to 9.07 ± 1.48 points at final follow-up (P < 0.0001). The Visual Analog Scale scores of thoracolumbar backaches were 5.3 ± 1.2 before surgery and 0.69 ± 0.75 at final follow-up (P = 0.001). No serious complications ensued. Limitations: This was a retrospective study with several limitations, including the lack of a control group, small number of included samples and unavoidable nature of the single-center study design. Conclusions: Translaminar osseous channel–assisted p-PEF technique, with less tissue trauma and impact on the stability of the spine, can provide adequate decompression and satisfying outcomes in the treatment of OLF-related TM and should be considered as an alternative procedure for isolated OLF. Key words: Translaminar osseous channel, percutaneous full-endoscopic flavectomy, thoracic myelopathy, ossification of ligamentum flavum, minimally invasive spine surgery

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Uni-Port Total Thoracoscopic Surgery Versus Median Sternotomy for Redo Tricuspid Valve Replacement: A Retrospective Study

The Heart Surgery Forum ◽

10.1532/hsf.2967 ◽

2020 ◽

Vol 23 (3) ◽

pp. E350-E357

Author(s):

Licheng Yan ◽

Fuzhen Zheng ◽

Haiyu Chen ◽

Jiayin Bao ◽

Guoxing Weng

Keyword(s):

Valve Replacement ◽

Tricuspid Valve ◽

Thoracoscopic Surgery ◽

Median Sternotomy ◽

Control Group ◽

Study Group ◽

Valve Regurgitation ◽

Tricuspid Valve Replacement ◽

Tricuspid Valve Regurgitation

Background: This study compared the perioperative and follow-up period data of patients who underwent redo tricuspid valve replacements performed via thoracoscopic surgery or median sternotomy. The purpose was to evaluate the feasibility, safety, and surgical outcomes of redo tricuspid valve replacement via uni-port thoracoscopic surgery. Methods: Forty-nine patients with severe tricuspid valve regurgitation after left-side valve replacement underwent redo tricuspid valve replacements in our hospital from April 2012 to September 2019. Twenty-six patients underwent uni-port total thoracoscopy surgery, whereas 23 patients had the surgery performed via median sternotomy. We collected perioperative and 3- to 36-month postoperative data. Results: No deaths occurred in the intraoperative period. Time of cardiopulmonary bypass in the study group significantly was longer than that in the control group (P < .05), but the operative times in the study and control groups were not significantly different. Thoracic drainage, length of ICU stay, postoperative hospital stay, and complication rates in the study group were significantly different from those in the control group (P < .05). Throughout the follow-up period, uni-port total thoracoscopic TVR was not inferior to traditional surgery with respect to cardiac function and recurrence of tricuspid valve regurgitation. Conclusions: Uni-port total thoracoscopic tricuspid valve replacement is safe, feasible and effective, and that can be considered as a primary treatment strategy for patients with severe TR after previous left-sided valve procedure.

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Midterm Results of a Minimally Invasive Approach in David Procedure

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0037-1603495 ◽

2017 ◽

Vol 66 (04) ◽

pp. 301-306 ◽

Cited By ~ 3

Author(s):

Petar Risteski ◽

Aleksandra Miskovic ◽

Anton Moritz ◽

Andreas Zierer ◽

Nadejda Monsefi

Keyword(s):

Minimally Invasive ◽

Heart Surgery ◽

Group Versus ◽

Transfusion Rate ◽

Midterm Results ◽

Minimally Invasive Approach ◽

Invasive Approach ◽

Invasive Group ◽

Packed Red Blood Cells

Background The David procedure is a well-known technique in selected patients with aortic root pathology. A minimally invasive approach in heart surgery increases open interest. Methods From 1991 to 2015, the David technique was performed in 296 patients in our unit. In 90 cases, operations were performed through partial upper sternotomy. The patient mean age was 57 ± 14 years in the minimally invasive group (n = 90) and 58 ± 14 years in the complete sternotomy group (n = 206; p = 0.2). The neosinus modification was performed in 80 patients (89%) in the minimally invasive group and in 79 patients (38%) in the complete sternotomy group (p < 0.01). Mean follow-up was 3 ± 2 years in the minimally invasive group and 8 ± 4 years in the complete sternotomy group. Results Thirty-day mortality was zero in the minimally invasive group and was 3% (n = 6) in the complete sternotomy group (p = 0.1). The need for packed red blood cells was significantly lower in the minimally invasive group (1.6 ± 3 U) than in the complete sternotomy group (3.7 ± 6 U; p < 0.01). Thirty late deaths (2% per patient-year) were observed in the complete sternotomy group versus zero in the minimally invasive group (p < 0.01). One patient (0.5% per patient-year) in the minimally invasive group and 12 patients (0.8% per patient-year) in the complete sternotomy group required reoperation in the follow-up period (p = 0.05). Conclusions Minimally invasive David technique for patients with ascending aortic aneurysm and aortic valve insufficiency offers a good solution with low perioperative blood transfusion rate. Our midterm results show low valve-related complications and reoperation rate. However, long-term follow-up of the minimally invasive group is necessary.

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Excision of Atrial Myxomas is progressing from Median Sternotomy to Mini-Thoracotomy.

10.22541/au.160589383.32672175/v1 ◽

2020 ◽

Author(s):

Yasser Mubarak

Keyword(s):

Length Of Stay ◽

Minimally Invasive ◽

Median Sternotomy ◽

Atrial Myxoma ◽

Pain Patient ◽

Benign Tumors ◽

Invasive Approach ◽

Cross Clamp Time ◽

Significant Difference

Background: Atrial myxomas are rare benign tumors; causing obstructive or embolic complications, and even death, depending on their site and size. Therefore, once diagnosed, it should be surgically resected emergency. Atrial myxomas are present about 75% in left atrium (LA) and about 15% in right atrium (RA). Early diagnosis is a challenge because of nonspecific manifestations, and sometimes is asymptomatic and discovered accidentally during TTE. Objective: Minimally invasive cardiac surgery (MICS) has benefits include cosmetically, less pain, shorter intensive care unit (ICU) and hospital stay. Methods: From Jan. 2011 to Sept. 2020, (20) patients (10 Sternotomy, 10 MI) underwent surgery for isolated resection of atrial myxoma. We reported outcomes; cardiopulmonary bypass time (CPB), cross-clamp time, conversion to median ST, length of stay, complications (stroke, renal failure, respiratory failure, reoperation, and infection),pain, patients satisfaction, recurrence and survival. Mean follow-up time was 6 month. Results: There is no significant difference in CPB or cross-clamp time between groups. No MI cases required conversion to a median ST. Length of stay is shorter in the MI group by 2.2 days (p = 0.045). There is no difference in morbidity or mortality between groups. Conclusions: A minimally invasive approach for atrial myxoma resection is safe, feasible, and favored over sternotomy.

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Surgical Technique: Papillary Muscle Sling for Functional Mitral Regurgitation during Minimally Invasive Valve Surgery

The Heart Surgery Forum ◽

10.1532/hsf98.2013209 ◽

2013 ◽

Vol 16 (5) ◽

pp. E295-E297 ◽

Cited By ~ 3

Author(s):

Joseph Lamelas ◽

Christos Mihos ◽

Orlando Santana

Keyword(s):

Mitral Regurgitation ◽

Minimally Invasive ◽

Median Sternotomy ◽

Rational Approach ◽

Functional Mitral Regurgitation ◽

Minimally Invasive Approach ◽

Invasive Approach ◽

Mitral Annuloplasty ◽

Technical Details ◽

Mitral Apparatus

In patients with functional mitral regurgitation, the placement of a sling encircling both papillary muscles in conjunction with mitral annuloplasty appears to be a rational approach for surgical correction, because it addresses both the mitral valve and the deformities of the subvalvular mitral apparatus. Reports in the literature that describe the utilization of this technique are few, and mainly involve a median sternotomy approach. The purpose of this communication is to describe the technical details of performing this procedure via a minimally invasive approach.

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Role and effectiveness of complex and supervised rehabilitation on overall and hand function in systemic sclerosis patients—one-year follow-up study

Scientific Reports ◽

10.1038/s41598-021-94549-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Michał Waszczykowski ◽

Bożena Dziankowska-Bartkowiak ◽

Michał Podgórski ◽

Jarosław Fabiś ◽

Arleta Waszczykowska

Keyword(s):

Systemic Sclerosis ◽

Hand Function ◽

Exercise Program ◽

Rehabilitation Program ◽

Long Term Results ◽

Home Exercise ◽

Control Group ◽

Study Group

AbstractThe aim of this study was to estimate the long-term results of complex and supervised rehabilitation of the hands in systemic sclerosis (SSc) patients. Fifty-one patients were enrolled in this study: 27 patients (study group) were treated with a 4-week complex, supervised rehabilitation protocol. The control group of 24 patients was prescribed a home exercise program alone. Both groups were evaluated at baseline and after 1-, 3-, 6-, and 12-months of follow-up with the Disability of the Arm, Shoulder and Hand Questionnaire (DAHS) as the primary outcome, pain (VAS—visual analog scale), Cochin Hand Function Scale (CHFS), Health Assessment Questionnaire Disability Index (HAQ-DI), Scleroderma-HAQ (SHAQ), range of motion (d-FTP—delta finger to palm, Kapandji finger opposition test) and hand grip and pinch as the secondary outcomes. Only the study group showed significant improvements in the DASH, VAS, CHFS and SHAQ after 1, 3 and 6 months of follow-up (P = 0.0001). Additionally, moderate correlations between the DASH, CHFS and SHAQ (R = 0.7203; R = 0.6788; P = 0.0001) were found. Complex, supervised rehabilitation improves hand and overall function in SSc patients up to 6 months after the treatment but not in the long term. The regular repetition of this rehabilitation program should be recommended every 3–6 months to maintain better hand and overall function.

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The effect of dry needling of myofascial trigger points on muscle stiffness and motoneuron excitability in healthy subjects

Acupuncture in Medicine ◽

10.1177/09645284211027579 ◽

2021 ◽

pp. 096452842110275

Author(s):

Carolina Jiménez-Sánchez ◽

Julio Gómez-Soriano ◽

Elisabeth Bravo-Esteban ◽

Orlando Mayoral-del Moral ◽

Pablo Herrero-Gállego ◽

...

Keyword(s):

Muscle Tone ◽

Intervention Group ◽

Trigger Points ◽

Muscle Stiffness ◽

Invasive Technique ◽

Control Group ◽

Dry Needling ◽

Myofascial Trigger Points ◽

Motoneuron Excitability

Background: Myofascial trigger points (MTrPs) are hypersensitive nodules in a taut band (TB) of skeletal muscle. Dry needling (DN) is an invasive technique recommended for the treatment of MTrPs. However, to our knowledge, no studies have investigated the influence of the DN technique on modification of muscle stiffness and neurophysiological properties of MTrPs. Objective: The objective was to examine the effect of DN on muscle stiffness and motoneuron excitability of a latent medial MTrP (nodule and TB) of the soleus muscle in non-injured subjects. Methods: A double-blinded randomised controlled trial of 46 subjects with latent medial MTrPs of the soleus was conducted, in which all received one session of DN. The intervention group (n = 23) were subjected to DN into the MTrP (the nodule), while the control group (n = 23) were subjected to DN into the TB. Assessment was carried out at baseline (pre-test), after the intervention (post-test) and 1 week after the intervention (follow-up). Biomechanical variables (muscle resistive force at 10°/s and 180°/s, muscle extensibility and strength), as measured with an isokinetic dynamometer, and neurophysiological variables (H-reflex), were recorded. Results: There were no statistically significant differences in biomechanical or neurophysiological assessments between groups. Considering the intra-group analysis, subjects in the intervention group exhibited increased maximal isometric voluntary force to ankle plantarflexion (MIVFp) at both post-intervention and follow-up assessment (p < 0.0125; 0.2 < d < 0.5), while no changes were found in the control group. Conclusion: One session of DN targeting latent MTrPs did not change muscle stiffness, muscle extensibility or motoneuron excitability. Further research on subjects with muscle tone disorders should be considered to better address the impact of DN on muscle tone. Trial registration number: NCT02575586 (ClinicalTrials.gov).

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