Minimally invasive approach for infective mitral valve endocarditis

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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Is a minimally invasive approach for re-operative mitral valve surgery superior to standard resternotomy?

Interactive Cardiovascular and Thoracic Surgery ◽

10.1510/icvts.2009.203448 ◽

2009 ◽

Vol 9 (2) ◽

pp. 327-332 ◽

Cited By ~ 12

Author(s):

M. Murzi ◽

M. Solinas ◽

M. Glauber

Keyword(s):

Mitral Valve ◽

Minimally Invasive ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Minimally Invasive Approach ◽

Invasive Approach

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Minimally invasive approach for aortic and mitral valve surgery

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezw208 ◽

2016 ◽

Vol 50 (6) ◽

pp. 1204-1205 ◽

Cited By ~ 6

Author(s):

Antonio Lio ◽

Antonio Miceli ◽

Matteo Ferrarini ◽

Mattia Glauber

Keyword(s):

Mitral Valve ◽

Minimally Invasive ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Minimally Invasive Approach ◽

Invasive Approach

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Minimally Invasive Approach for Mitral Valve Repair in a Patient With Prior Pentalogy of Fallot Repair

Seminars in Thoracic and Cardiovascular Surgery ◽

10.1053/j.semtcvs.2012.01.005 ◽

2012 ◽

Vol 24 (2) ◽

pp. 144-145

Author(s):

Pey-Jen Yu ◽

Aubrey C. Galloway

Keyword(s):

Mitral Valve ◽

Minimally Invasive ◽

Mitral Valve Repair ◽

Valve Repair ◽

Minimally Invasive Approach ◽

Invasive Approach

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Minimally Invasive Mitral Valve Replacement Using the Valve-in-valve Technique

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0b013e3181b02871 ◽

2009 ◽

Vol 4 (4) ◽

pp. 221-224 ◽

Cited By ~ 1

Author(s):

Orlando Santana ◽

Francisco A. Tarrazzi ◽

Joseph Lamelas

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Minimally Invasive ◽

Pulmonary Edema ◽

Left Atrium ◽

Bioprosthetic Valve ◽

Minimally Invasive Approach ◽

Invasive Approach ◽

Valve In Valve ◽

Bioprosthetic Mitral Valve

A 90-year-old woman with two previous mitral valve replacements, presented with pulmonary edema due to mitral regurgitation from degeneration of her bioprosthetic mitral valve. A minimally invasive approach was used to replace the bioprosthetic mitral valve. During surgery, the bioprosthetic valve was noted to be too adherent to the endocardium of the left atrium, making removal of the prosthesis not only difficult, but also potentially harmful. The new bioprosthetic valve was instead placed using a valve-in-valve approach.

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Robotic Multisegment Triangular Resections as an Alternative to Sliding Leaflet Plasty

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0b013e3182a2703f ◽

2013 ◽

Vol 8 (3) ◽

pp. 237-241

Author(s):

Faisal H. Cheema ◽

Stephen Cheung ◽

Jeffrey Jiang ◽

Muhammad Jabran Younus ◽

Harold G. Roberts

Keyword(s):

Mitral Valve ◽

Minimally Invasive ◽

Posterior Leaflet ◽

Mitral Leaflet ◽

Valve Repair ◽

Minimally Invasive Approach ◽

Invasive Approach ◽

Posterior Mitral Leaflet ◽

Simple Alternative ◽

Complex Procedure

The sliding leaflet plasty of the posterior mitral leaflet is a complex procedure, both lengthy and technically challenging. A simple alternative is desirable, particularly for a minimally invasive approach. We report a distinct substitute to the conventional sliding leaflet plasty that included triangular resections of P2 and P3 using a robot. These multiple triangular resections enabled a successful mitral valve repair with satisfactory clinical and echocardiographic results. Recognizing the complexity of sliding leaflet plasties, we note that multisegment triangular resections seem to be an easy, expeditious, and effective alternative for the posterior leaflet that is readily performed via a robotic endoscopic approach.

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