Use of an automated knot fastener shortens operative times in minimally invasive mitral valve repair

Introduction Longer durations of cardiopulmonary bypass and aortic cross clamp are associated with increased morbidity and mortality. Little is known about the effect of automated knot fasteners (Cor-Knot®) in minimally invasive mitral valve repair on operative times and outcomes. The aim of this study was to evaluate whether these devices shortened cardiopulmonary bypass and aortic cross clamp times and whether this impacted on postoperative outcomes. Materials and methods All patients undergoing isolated minimally invasive mitral valve repair by a single surgeon between March 2011 and March 2016 were included (n = 108). Two cohorts were created based on the use (n = 52) or non-use (n = 56) of an automated knot fastener. Data concerning intraoperative variables and postoperative outcomes were collected and compared. Results Preoperative demographics were well matched between groups with no significant difference in logistic Euroscore (manual vs automated: median 3.1, interquartile range, IQR, 2.1–5.5, vs 5.4, IQR 2.2–8.3; P = 0.07, respectively). Comparing manually tied knots to an automated fastener, cardiopulmonary bypass and aortic cross clamp times were significantly shorter in the automated group (cardiopulmonary bypass: median 200 minutes, IQR 180–227, vs 165 minutes (IQR 145–189 minutes), P < 0.001; aortic cross clamp 134 minutes (IQR 121–150 minutes) vs 111 minutes (IQR 91–137 minutes), P < 0.001, respectively). There was no mortality and no strokes, nor were there any differences in postoperative outcomes including reoperation for bleeding, renal failure, intensive care or hospital stay. Conclusions The use of an automated knot fastener significantly reduces cardiopulmonary bypass and aortic cross clamp times in minimally invasive mitral valve repair but this does not translate into an improved clinical outcome.

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Concomitant Tricuspid Valve Repair during Minimally Invasive Mitral Valve Repair

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0039-1700506 ◽

2019 ◽

Vol 68 (06) ◽

pp. 486-491

Author(s):

Bettina Pfannmueller ◽

Martin Misfeld ◽

Piroze Davierwala ◽

Stefan Weiss ◽

Michael Andrew Borger

Keyword(s):

Cardiopulmonary Bypass ◽

Mitral Valve ◽

Minimally Invasive ◽

Tricuspid Valve ◽

Early Mortality ◽

Tricuspid Valve Repair ◽

Valve Repair ◽

Invasive Approach ◽

Cardiopulmonary Bypass Time ◽

Significant Difference

Abstract Background Concomitant use of tricuspid valve (TV) surgery and minimally invasive mitral valve (MV) repair is debatable due to a prolonged time of surgery with presumably elevated operative risk. Herein, we examined cardiopulmonary bypass times and 30-day mortality in patients who underwent MV repair with and without concomitant TV surgery. Methods We retrospectively evaluated 3,962 patients with MV regurgitation who underwent minimally invasive MV repair without (n = 3,463; MVr group) and with (n = 499; MVr + TVr group) concomitant TV surgery between 1999 and 2014. Preoperative parameters between the groups were significantly different; therefore, propensity score matching was performed. Results Mean cardiopulmonary bypass time for all patients was 125.5 ± 55.8 minutes in MVr and 162.0 ± 58.0 minutes in MVr + TVr (p < 0.001). Overall 30-day mortality was significantly different between these groups (4.8 vs. 2.1%; p < 0.001); however, after adjustment, there was no significant difference (3.3 vs. 1.2%; p = 0.07). Backward logistic regression revealed that cardiopulmonary bypass time was not a significant predictor for early mortality within the MVr + TVr cohort. Conclusion Concomitant TV repair using prosthetic rings through a minimally invasive approach is safe and does not lead to elevated early mortality in our patient cohort. Therefore, prolonged cardiopulmonary bypass time should not be the sole reason to rule out MV repair with concomitant TV repair and to prefer the use of suture techniques, which saves only a few minutes compared with prosthetic ring implantation.

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Minimally invasive mitral valve repair for degenerative etiology: a comparative study

The Cardiothoracic Surgeon ◽

10.1186/s43057-021-00055-2 ◽

2021 ◽

Vol 29 (1) ◽

Author(s):

Mohamed Abdel Hafez Fouly ◽

Tarek K. Mousa

Keyword(s):

Mitral Valve ◽

Minimally Invasive ◽

Mitral Valve Repair ◽

Median Sternotomy ◽

Mitral Valve Surgery ◽

Valve Repair ◽

Significant Difference ◽

The Mean ◽

Group 2

Abstract Background There is a paucity of data comparing the minimally invasive mitral valve repair (MiMVr) to the conventional approach in patients with degenerative disease. Our objective was to compare the outcomes of MiMVr to the traditional mitral valve repair through median sternotomy in patients with degenerative mitral valve disease. We conducted a retrospective study on 215 patients classified into two groups. Group 1 (n = 80) included those who had mitral valve repair through a right anterolateral video-assisted mini-thoracotomy, and group 2 (n = 135) was approached through a conventional median sternotomy. We compared the preoperative, operative, and postoperative data between groups. Both groups had echocardiographic follow-ups after 6 and 12 months. Results There was no difference in gender distribution between both groups, and patients who had median sternotomy were significantly older (median 37 (Q1-Q3, 29-44) vs. 54 (48-60) years; P < 0.001). Cardiopulmonary bypass (134.5 (130-138.5) vs. 99 (97-104) min; P < 0.001) and ischemic times (99 (95-105.5) vs. 78 (75-81) min; P < 0.001) were significantly shorter in patients who had median sternotomy. Patients with MiMVr had significantly lower blood loss (370 (315-390) vs. 550 (490-600) ml; P < 0.001) and ICU stay (5 (4.5-6) vs. 7 (7-8) days; P < 0.001). There was no difference between both groups regarding re-exploration for bleeding, postoperative stroke, wound infection, renal failure, and mortality. As regards postoperative echocardiography follow-up at 6 and 12 months after the operation, there were no significant changes in the mean mitral valve gradient within each group; however, the mean gradient was lower in the MiMVr group (3 (3-3.5) vs. 4 (3-5) mmHg; P < 0.001). There was no significant difference between both groups regarding mitral regurgitation severity during 6 and 12 months follow-up. Conclusion Minimally invasive mitral valve repair in patients with degenerative pathology could be an alternative to conventional mitral valve surgery with comparable short-term and long-term outcomes.

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Commentary: Transitioning to Minimally Invasive Mitral Valve Repair—Navigating the Gauntlet

Seminars in Thoracic and Cardiovascular Surgery ◽

10.1053/j.semtcvs.2020.06.029 ◽

2020 ◽

Vol 32 (4) ◽

pp. 838-839

Author(s):

Jason J. Han ◽

Benjamin Smood ◽

Pavan Atluri

Keyword(s):

Mitral Valve ◽

Minimally Invasive ◽

Mitral Valve Repair ◽

Valve Repair

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10-Year Follow-up of 1,829 Patients Undergoing Minimally Invasive Mitral Valve Repair: A Single-Center Experience

10.1055/s-0040-1705438 ◽

2020 ◽

Author(s):

H. Schaefer ◽

D. Krankenberg ◽

U. Walle ◽

M. Liebrich ◽

D. Roser ◽

...

Keyword(s):

Mitral Valve ◽

Minimally Invasive ◽

Mitral Valve Repair ◽

Single Center ◽

Valve Repair ◽

Single Center Experience

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DL-based segmentation of endoscopic scenes for mitral valve repair

Current Directions in Biomedical Engineering ◽

10.1515/cdbme-2020-0017 ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Matthias Ivantsits ◽

Lennart Tautz ◽

Simon Sündermann ◽

Isaac Wamala ◽

Jörg Kempfert ◽

...

Keyword(s):

Mitral Valve ◽

Minimally Invasive ◽

Mitral Valve Repair ◽

Video Stream ◽

Field Of View ◽

Valve Repair ◽

Distance Measurements ◽

Anatomical Structures ◽

Endoscopic Video ◽

Camera Position

AbstractMinimally invasive surgery is increasingly utilized for mitral valve repair and replacement. The intervention is performed with an endoscopic field of view on the arrested heart. Extracting the necessary information from the live endoscopic video stream is challenging due to the moving camera position, the high variability of defects, and occlusion of structures by instruments. During such minimally invasive interventions there is no time to segment regions of interest manually. We propose a real-time-capable deep-learning-based approach to detect and segment the relevant anatomical structures and instruments. For the universal deployment of the proposed solution, we evaluate them on pixel accuracy as well as distance measurements of the detected contours. The U-Net, Google’s DeepLab v3, and the Obelisk-Net models are cross-validated, with DeepLab showing superior results in pixel accuracy and distance measurements.

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