scholarly journals Comparison of Left Atriotomy and Superior Transseptal Approaches in Mitral Valve Surgery

2018 ◽  
Vol 21 (4) ◽  
pp. E318-E321 ◽  
Author(s):  
Saygin Turkyilmaz ◽  
Ali Aycan Kavala
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Cardiopulmonary Bypass ◽  
Mitral Valve ◽  
Intensive Care Unit Stay ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Time Duration ◽  
Cardiopulmonary Bypass Time ◽  
Hospitalization Time

Purpose: To compare the operative and post-operative outcomes of mitral valve surgery (MVS) with a superior transseptal (STS) approach and a left atriotomy (LA) approach. Methods: In a tertiary academic center, the charts of patients who underwent MVS between 2012 and 2016 were analyzed retrospectively. A total of 135 patients underwent MVS. Forty patients who underwent MVS with the STS approach were enrolled in the study as the STS group. In the same period, we selected 40 patients who underwent MVS with the LA approach to serve as the control group (LA group). Two groups were operated by the same surgeon. To minimize the bias related to the lack of randomization in this observational study, LA group patients were selected using propensity score matching. Results: According to the study design, the preoperative characteristics of gender, age, mitral valve stenosis, and mitral valve insufficiency were matched (P = .368, P = .920, P = .250 and P = .057, respectively). The cardiopulmonary bypass time was 91.2 ± 12.1 minutes in the superior transseptal group and 72.8 ± 6.4 minutes in the left atriotomy group (P < .001). Additionally, duration of clamp time was significantly shorter in the left atriotomy group (P < .001). Estimated blood loss was significantly less in patients with a left atriotomy (535.8 ml versus 658.0 mL, P < .001). Duration of intensive care unit stay and hospitalization time were significantly longer in patients who underwent the superior transseptal approach compared with patients who underwent left atriotomy (P < .001 versus P < .001, respectively). Post-operative dysrhythmia rate and mortality rate were similar between the groups. Conclusion: Our study demonstrated that MVS with LA decreased cardiopulmonary bypass time, duration of clamp time, amount of hemorrhage, duration of intensive care unit stay, and hospitalization time compared with MVS with STS.

Robotically Controlled Video-Assisted Port-Access Mitral Valve Surgery

2002 ◽  
Vol 10 (2) ◽  
pp. 133-136 ◽  
Author(s):  
Naresh Trehan ◽  
Yugal K Mishra ◽  
Mitesh Sharma ◽  
Surinder Bazaz ◽  
Yatin Mehta ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Mitral Valve ◽  
Blood Loss ◽  
Hospital Stay ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Postoperative Blood Loss ◽  
Hospital Death ◽  
Port Access

From 1997 to 2000, 221 patients underwent mitral valve surgery through a mini-thoracotomy, using a port-access endovascular cardiopulmonary bypass system in 38 and a transthoracic clamp in 183. In 120 patients, exposure of the mitral valve was facilitated by an endoscope attached to a voice-controlled robotic arm (AESOP 3000). The mitral valve was repaired in 26 patients and replaced in 195; 24 were redo cases. Operating time was 3.5 ± 1.2 hours, aortic crossclamp time was 58 ± 16 minutes, intensive care unit stay was 22 ± 7 hours, and hospital stay was 6.4 ± 1.2 days. Median postoperative blood loss was 332 ± 104 mL. There was 1 hospital death. On follow-up at 16.4 ± 12.2 months, there was no late death or reoperation. New York Heart Association functional class improved from 2.6 ± 0.5 to 1.4 ± 0.8. Use of video and robotic assistance minimized incision length and allowed visualization of the whole mitral valve apparatus. The transthoracic clamp facilitated aortic crossclamping and injection of cardioplegia. These findings indicate that the procedure is safe and effective and suggest advantages over conventional surgery in terms of cost, cosmesis, blood loss, postoperative discomfort, intensive care unit and hospital stay.

Use of Enoximone in Weaning from Cardiopulmonary Bypass following Mitral Valve Surgery

Cardiology ◽  
1990 ◽  
Vol 77 (3) ◽  
pp. 51-57 ◽  
Author(s):  
T.J. Tarr ◽  
R.R. Jeffrey ◽  
A.P. Kent ◽  
M.E. Cowen
Keyword(s):  
Cardiopulmonary Bypass ◽  
Mitral Valve ◽  
Mitral Valve Surgery ◽  
Valve Surgery

Robotic Mitral Valve Surgery and Unilateral Pulmonary Edema

2020 ◽  
pp. 171-178
Author(s):  
Cindy Cheung ◽  
Christopher W. Tam
Keyword(s):  
Cardiopulmonary Bypass ◽  
Mitral Valve ◽  
Minimally Invasive ◽  
Pulmonary Edema ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Blood Product Transfusion ◽  
Unilateral Pulmonary Edema ◽  
Less Invasive Approach ◽  
The Difference

This chapter describes robotic or minimally invasive mitral valve surgery, which was pioneered in 1998 to be the less invasive approach to sternotomy-based mitral valve operations. Patients undergoing robotic valve surgery carry a similar risk of complications that may occur with traditional median sternotomy surgery, but minimally invasive valve surgery has its own inherent complications associated with cardiac access, perfusion, and ventilation methods used in robotic surgeries. Unilateral pulmonary edema (UPE) is an uncommon but potentially life-threatening complication of robotic mitral valve surgery. The incidence of unilateral lung injury, which commonly manifests as UPE, has been reported to be quite variable. The variation in incidence could be related to the difference in patient populations, diagnostic criteria, as well as management. Moreover, the pathophysiology of UPE associated with robotic mitral valve repair remains unclear. The current literature suggests that UPE can be prevented by shorter cardiopulmonary bypass times, avoiding barotrauma, limiting blood product transfusion, and minimizing lung isolation times. Lung preventive ventilation, such as low-level positive pressure and frequent alveolar recruitment, while on cardiopulmonary bypass may be beneficial. Meanwhile, treatment for UPE is dependent on the severity of symptoms.

Duplex Ultrasound Mapping Protocol for Placement of Cardiopulmonary Bypass Cannulae for Robotic Mitral Valve Surgery

2011 ◽  
Vol 35 (3) ◽  
pp. 143-147
Author(s):  
Alia G. Grattan ◽  
Alexa Digiannantonio ◽  
Tomislav Mihaljevic ◽  
A. Marc Gillinov ◽  
Heather L. Gornik
Keyword(s):  
Cardiopulmonary Bypass ◽  
Mitral Valve ◽  
Duplex Ultrasound ◽  
Mitral Valve Surgery ◽  
Valve Surgery

Femoral cannulation for cardiopulmonary bypass with a novel bidirectional perfusion cannula

2021 ◽  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Mitral Valve ◽  
Minimally Invasive ◽  
Femoral Artery ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
The Novel ◽  
Postoperative Course ◽  
Video Tutorial ◽  
Percutaneous Cannulation

The use of the novel bidirectional femoral cannula is described in this video tutorial. We demonstrate the percutaneous cannulation and decannulation of the femoral artery for cardiopulmonary bypass in a patient undergoing minimally invasive mitral valve surgery. The procedure itself is presented step by step for each important phase. Finally, we report the postoperative course following the successful use of a peripheral bidirectional cannula.

scholarly journals BEATING HEART MITRAL VALVE REPLACEMENT. EXPERIENCE AT A TERTIARY CARE HOSPITAL

2021 ◽  
Vol 70 (Suppl-4) ◽  
pp. S809-13
Author(s):  
Musfireh Siddiqeh ◽  
Imran Khan ◽  
Fakher -e- Fayaz ◽  
Asif Janjua ◽  
Ali Gohar Zamir ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Stenosis ◽  
Mitral Valve Surgery ◽  
Beating Heart ◽  
Valve Surgery ◽  
Tricuspid Valve Repair ◽  
Valve Prosthesis ◽  
Care Hospital

Objective: To study the early outcomes of mitral valve surgery performed with a beating heart and cardiopulmonary bypass. Study Design: Prospective descriptive study. Place and Duration of Study: Cardiac Surgery department, Rawalpindi Institute of Cardiology, Rawalpindi, from Aug 2017 to Aug 2019. Methodology: Consecutive patients requiring mitral valve surgery were included in the study. Those requiring multiple procedures, redo procedures and emergency procedures were excluded from the study. Data was collected on preformed proformas and perioperative variables were recorded. Patients were followed till discharge or 30 days after the surgery. Statistical Package for Social Sciences version 23.0 was used to analyse the data. Results: A total of 27 patients were included in the study, 21 (77.78%) female and 6 (22.2%) male patients. The mean age of the patients was 30.89 ± 10.8 years. Of the cohort, 4 (14.8%) had mitral stenosis, 16 (59.3%) had mitral regurgitation and mixed disease (both mitral stenosis and mitral regurgitation) was present in 7 (25.9%). The median pulmonary artery pressure (mPAP) was 34 mmHg. All the patients received mechanical mitral valve prosthesis, 27 (100%). A modified Devaga’s procedure for tricuspid valve repair was done in 4 (14.8%) patients. Most of the patients required only mild inotropic support, 22 (81.4%). Median intensive care unit stay was 24 hours with a mean of 33 ± 16 hours. All the patients were alive at the end of the early follow up. Conclusion: Beating heart mitral valve surgery on cardiopulmonary bypass is a feasible technique. It has acceptable early outcome in terms of mortality and major morbidity indicators.

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