Anaesthetic Management for Minimally Invasive approach for ASD closure, Mitral valve replacement and Tricuspid valve repair in a patient with Lutembacher syndrome

Background: Minimally invasive mitral valve surgery became an attractive option because of its cosmetic advantages over the conventional approach. The superiority of the minimally invasive approach regarding other aspects is still debatable. The aim of our study was to determine the potential benefits of minimally invasive mitral valve replacement with intraoperative video assistance over conventional surgery. Methods: This is a single-center prospective cohort study that included 60 patients with rheumatic heart disease who underwent mitral valve replacement. Patients were divided into two groups: group (A) included patients who had conventional sternotomy (n= 30), and group (B) included patients who had video-assisted minimally invasive mitral valve replacement (n= 30). Intraoperative and postoperative outcomes were compared between both groups. Results: Mortality occurred in one patient in the group (A). Cardiopulmonary bypass time was 118.93 ± 29.84 minutes vs. 64.73 ± 19.16 minutes in group B and A respectively (p< 0.001), and ischemic time was 102.27 ± 30.03 minutes vs. 53.67± 18.46 minutes in group B and A respectively (P < 0.001). Ventilation time was 2.77± 2.27 vs. 6.28 ± 4.48 hours in group B and A respectively (p< 0.001) and blood transfusion was 0.50 ± 0.63 vs. 2.83 ± 1.34 units in group B and A respectively (p< 0.001). ICU stay was 1.73 ± 0.64 days in the group (B) vs. 4.47 ± 0.94 days in group A (p< 0.001). Postoperative bleeding was 353.33 ± 146.77 ml in the group (B) vs. 841.67 ± 302.03 ml in group A (p <0.001). No conversion to full sternotomy was reported in group B. In group (B), two cases (6.6%) required re-exploration for bleeding vs. four cases (13.2%) in group (A) (p=0.67). The hospital stay was 6.13 ± 1.59 days in the group (B) vs. 13.27 ± 7.62 days in group A (p< 0.001). Four cases (13.3%) developed mediastinitis in group A and in the group (B), there was one case of acute right lower limb embolic ischemia. Conclusion: Video-assisted minimally invasive mitral operations could be a safe alternative to conventional sternotomy with the potential of lesser morbidity and earlier hospital discharge.

Download Full-text

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.

Download Full-text

Use of Suture tightening automated device COR-KNOT® for minimally invasive heart valve surgery: Our initial experience in Bangladesh

Bangladesh Heart Journal ◽

10.3329/bhj.v34i2.44444 ◽

2019 ◽

Vol 34 (2) ◽

pp. 127-131

Author(s):

Md Faizus Sazzad ◽

Nusrat Ghafoor ◽

Siba Pada Roy ◽

Swati Munshi ◽

Feroza Khanam ◽

...

Keyword(s):

Mitral Valve ◽

Minimally Invasive ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Heart Valve ◽

Mitral Valve Repair ◽

Case Series ◽

Valve Surgery ◽

Heart Valve Surgery ◽

Valve Repair

Background: COR-KNOT® (LSI Solutions, New York, NY, USA) is an automated suture securing device has not been well known. We report a case series for first automated knotting device used for minimally invasive heart valve surgery in Bangladesh. Method and Results: To overcome the challenge of knot securing via a Key-Hole surgery we have used CORKNOT ®. The newest device is capable of remotely and automatically secure sutures and simultaneously can cut and remove the excess suture tails. We covered the spectrum of heart valve surgery: There was one case of bioprosthetic aortic valve replacement, one case of mitral valve repair, one case of bioprosthetic mitral valve replacement, one case of failed mitral valve repair with COR-KNOT® explantation followed by mechanical mitral valve replacement and one case of redo-mitral valve replacement. Average length of hospital stays was 5 ± 1days. There was one reopening, one post-operative atrial fibrillation. No wound infection and no 30day mortality. Conclusion: We conclude, COR-KNOT® is a safe and effective tool to reduce the duration of operation. Clinical outcome of heart valve surgery with COR-KNOT® is comparable with other methods of suture tying methods. Bangladesh Heart Journal 2019; 34(2) : 127-131

Download Full-text

Retrospective Study of the Outcome of Mitral Valve Replacement with or without Tricuspid Valve Repair in Ain Shams University

QJM ◽

10.1093/qjmed/hcaa042.010 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

A M A Elfeky ◽

M M A Fadala ◽

O A Abdelhameed ◽

R M R Khorshid

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Tricuspid Valve ◽

Mitral Valve Disease ◽

Valve Disease ◽

Morbidity And Mortality ◽

Tricuspid Valve Repair ◽

Valve Repair ◽

Number Of Patients

Abstract Background Rheumatic mitral valvular disease is more common than degenerative mitral valve disease. Mitral valve repair is not possible in large number of patients because of rheumatic cicatrized subvalvular mitral valve disease. The prosthetic mitral valve replacement is commonly performed in our center. Objective The aim of the study was to evaluate and assess the short outcome of Mitral Valve Replacement with or without Tricuspid Valve Repair. Patients and Methods This study was done in department of Cardiothoracic surgery, Faculty of Medicine at Ain Shams university, after approval of the local ethical committee from 2015 to 2016.The inclusion criteria includes All gender, All age, Primary Mitral valve replacement for severe Mitral valve disease of Rheumatic origin with or without Tricuspid Valve Repair and Primary Mitral valve replacement for severe Mitral valve disease of Degenerative origin with or without Tricuspid Valve Repair and the exclusion criteria includes concomitant coronary artery bypass graft surgery or other cardiac operations or infective endocarditis and Patients with chronic liver, kidney and parenchymal pulmonary disease. Results This study included one hundred and seventy- seven (177) patients; One hundred and thirty one (131) patients did Mitral Valve Replacement without Tricuspid valve Repair, Fourty six (46) patients did Mitral valve Replacement with Tricuspid valve Repair and the outcome was Mortality (3.9%), Reoperaion (5.08%), Stroke (0. 56%), Re-Intubation (1.13%) and Re-Admission to ICU (1.69%) Conclusion The Reoperation has a direct relation and effect on the Mortality,Prolonged bypass time independently predicts postoperative morbidity and mortality and Prolonged aortic cross-clamp time significantly correlates with major post-operative morbidity and mortality.

Download Full-text