How to create patient-specific loops for correcting mitral valve prolapse through a minimally invasive approach

Abstract Objective The aim of this study was to evaluate the accuracy of patient-specific three-dimensional printed drill guides (3D-PDG) for the placement of a coxofemoral toggle via a minimally invasive approach. Materials and Methods Pre-procedure computed tomography (CT) data of 19 canine cadaveric hips were used to design a cadaver-specific 3D-PDG that conformed to the proximal femur. Femoral and acetabular bone tunnels were drilled through the 3D-PDG, and a coxofemoral toggle pin was placed. The accuracy of tunnel placement was evaluated with post-procedure CT and gross dissection. Results Coxofemoral toggle pins were successfully placed in all dogs. Mean exit point translation at the fovea capitis was 2.5 mm (0.2–7.5) when comparing pre- and post-procedure CT scans. Gross dissection revealed the bone tunnel exited the fovea capitis inside (3/19), partially inside (12/19) and outside of (4/19) the ligament of the head of the femur. Placement of the bone tunnel through the acetabulum was inside (16/19), partially inside (1/19) and outside (2/19) of the acetabular fossa. Small 1 to 2 mm articular cartilage fragments were noted in 10 of 19 specimens. Clinical Significance Three-dimensional printed drill guide designed for coxofemoral toggle pin application is feasible. Errors are attributed to surgical execution and identification of the borders of the fovea capitis on CT data. Future studies should investigate modifications to 3D-PDG design and methods. Three-dimensional printed drill guide for coxofemoral toggle pin placement warrants consideration for use in select clinical cases of traumatic coxofemoral luxation.

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Fifteen-year experience with minimally invasive approach for reoperations involving the mitral valve

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2011.06.036 ◽

2012 ◽

Vol 143 (5) ◽

pp. 1062-1068 ◽

Cited By ~ 47

Author(s):

Joseph M. Arcidi ◽

Evelio Rodriguez ◽

Joseph R. Elbeery ◽

L. Wiley Nifong ◽

Jimmy T. Efird ◽

...

Keyword(s):

Mitral Valve ◽

Minimally Invasive ◽

Minimally Invasive Approach ◽

Invasive Approach

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Minimally invasive approach for infective mitral valve endocarditis

Annals of Cardiothoracic Surgery ◽

10.21037/acs.2019.07.01 ◽

2019 ◽

Vol 8 (6) ◽

pp. 702-704 ◽

Cited By ~ 1

Author(s):

Karel M. Van Praet ◽

Markus Kofler ◽

Simon H. Sündermann ◽

Matteo Montagner ◽

Roland Heck ◽

...

Keyword(s):

Mitral Valve ◽

Minimally Invasive ◽

Minimally Invasive Approach ◽

Invasive Approach

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An 86-Year-Old Female with Mitral Regurgitation and Significant Pectus Excavatum

The Thoracic and Cardiovascular Surgeon Reports ◽

10.1055/s-0039-1700881 ◽

2019 ◽

Vol 08 (01) ◽

pp. e37-e40

Author(s):

Raphael Tasar ◽

Sophie Tkebuchava ◽

Mahmoud Diab ◽

Torsten Doenst

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Minimally Invasive ◽

Pectus Excavatum ◽

Heart Team ◽

Case Description ◽

Valve Repair ◽

Minimally Invasive Approach ◽

Invasive Approach ◽

Surgical Access

Abstract Background We report the case of minimally invasive mitral valve repair in an 86-year-old female with symptomatic structural mitral regurgitation and severe pectus excavatum. Case Description The case summarizes four areas of repetitive heart team discussions. First, should an 86-year-old patient still be treated invasively? Second, if so, should treatment be interventional or surgical? Third, if surgical, should we replace or repair at that age and fourth which surgical access is best with respect to her chest deformation? Conclusion We chose to surgically repair the valve using a minimally invasive approach. The patient was extubated 3 hours after surgery and discharged after 7 days.

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A Simplified Technique for Correcting Mitral Valve Regurgitation via Minimally Invasive Approach

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000497 ◽

2018 ◽

Vol 13 (3) ◽

pp. 236-238

Author(s):

Giuseppe Speziale ◽

Marco Moscarelli

Keyword(s):

Cardiopulmonary Bypass ◽

Mitral Valve ◽

Mitral Regurgitation ◽

Minimally Invasive ◽

Mitral Valve Regurgitation ◽

Valve Regurgitation ◽

Minimally Invasive Approach ◽

Invasive Approach ◽

Repair Techniques

Mitral valve regurgitation may require complex repair techniques that are challenging in minimally invasive and may expose patients to prolonged cardiopulmonary bypass and cross-clamp times. Here, we present a stepwise operative approach that may facilitate the repair of the mitral valve in a minimally invasive fashion and may be carried out even when multiple posterior segments are involved. This how-to-do article presents a method that was performed in 148 patients that were referred to our institution for severe organic mitral regurgitation between 2008 and 2016. At mean ± SD follow-up of 45.5 ± 27 months, freedom from recurrent of mitral regurgitation 2+ or greater and reoperation was 95.2%.

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Obesity Should Not Deter a Surgeon from Selecting a Minimally Invasive Approach for Mitral Valve Surgery

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0b013e3182a20e5a ◽

2013 ◽

Vol 8 (3) ◽

pp. 225-229 ◽

Cited By ~ 9

Author(s):

Diana Reser ◽

Simon Sündermann ◽

Jürg Grünenfelder ◽

Jacques Scherman ◽

Burkhardt Seifert ◽

...

Keyword(s):

Mitral Valve ◽

Minimally Invasive ◽

Mitral Valve Surgery ◽

Normal Weight ◽

Valve Surgery ◽

Cerebrovascular Event ◽

Minimally Invasive Approach ◽

Term Outcome ◽

Invasive Approach ◽

Postoperative Ventilation

Objective Obesity is highly prevalent in modern patient populations. Several studies have published conflicting outcomes after minimally invasive surgery with regard to morbidity and mortality. Some instances consider obesity as a relative contraindication for this approach because of inadequate exposure of the surgical field. Our aim was to investigate the outcomes of minimally invasive mitral valve surgery through a right lateral minithoracotomy in patients with a body mass index (BMI) of 30 kg/m2 or greater. Methods We conducted a retrospective database review between January 1, 2009, and December 31, 2011. Preoperative, intraoperative, postoperative, and follow-up data of 225 consecutive patients were collected. Results The patients were stratified according to their BMI: 108 had a normal weight with a BMI of lower than 25 kg/m2 (18–24), 90 were overweight with a BMI of 25 to 29 kg/m2, and 27 were obese with a BMI of 30 kg/m2 (30–41) or greater. Statistical analysis showed significantly longer ventilation times in the obese group, whereas all other variables were similar. Survival, major adverse cardiac and cerebrovascular event-free survival, valve competency, and freedom from reoperation were also comparable. Conclusions Our data suggest that obesity should not deter a surgeon from selecting a minimally invasive approach. Despite longer postoperative ventilation times, a BMI of 30 kg/m2 or greater does not influence short- and medium-term outcome. Obese patients may even benefit from this approach because it avoids the need for sternotomy and therefore reduces the risk for sternal wound infection.

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