Ministernotomy: A preliminary experience in heart valve surgery

Background/Aim. The last decade of the 20th century brought up a significant development in the field of minimally invasive approaches to the valvular heart surgery. Potential benefits of this method are: good esthetic appearance, reduced pain, reduction of postoperative hemorrhage and incidence of surgical site infection, shorter postoperative intensive care units (ICU) period and overall in-hospital period. Partial upper median sternotomy currently presents as a state-of-the art method for minimally invasive surgery of cardiac valves. The aim of this study was to report on initial experience in application of this surgical method in the surgery of mitral and aortic valves. Methods. The study was designed and conducted in a prospective manner and included all the patients who underwent minimally invasive cardiac valve surgery through the partial upper median sternotomy during the period November 2008 - August 2009. We analyzed the data on mean age of patients, mean extubation time, mean postoperative drainage, mean duration of hospital stay, as well as on occurance of postoperative complications (postoperative bleeding, surgical site infection and cerebrovascular insult). Results. During the observed period, in the Institute for Cardiovascular Diseases of Vojvodina, Clinic for Cardiovascular Surgery, 17 ministernotomies were performed, with 14 aortic valve replacements (82.35%) and 3 mitral valve replacements (17.65%). Mean age of the patients was 60.78 ? 12.99 years (64.71% males, 35.29% females). Mean extubation time was 12.53 ? 8.87 hours with 23.5% of the patients extubated in less than 8 hours. Mean duration of hospital stay was 12.35 ? 10.17 days (in 29.4% of the patients less than 8 days). Mean postoperative drainage was 547.06 ? 335.2 mL. Postoperative complications included: bleeding (5.88%) and cerebrovascular insult (5.88%). One patient (5.88%) required conversion to full sternotomy. Conclusion. Partial upper median sternotomy represents the optimal surgical method for the interventions on the whole ascendant aorta (including aortic valve) and mitral valve through the roof of the left atrium, with a few significant advantages compared to the full sternotomy surgical approach.

Download Full-text

Totally endoscopic mitral valve surgery: early experience in 188 patients

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01464-4 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Yi Chen ◽

Ling-chen Huang ◽

Dao-zhong Chen ◽

Liang-wan Chen ◽

Zi-he Zheng ◽

...

Keyword(s):

Mitral Valve ◽

Minimally Invasive ◽

Mitral Valve Disease ◽

Median Sternotomy ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Valve Disease ◽

Endoscopic Technique ◽

Venous Cannula ◽

Defect Repair

Abstract Introduction Totally endoscopic technique has been widely used in cardiac surgery, and minimally invasive totally endoscopic mitral valve surgery has been developed as an alternative to median sternotomy for many patients with mitral valve disease. In this study, we describe our experience about a modified minimally invasive totally endoscopic mitral valve surgery and reported the preliminary results of totally endoscopic mitral valve surgery. The aim of this retrospective study is to evaluate the results of totally endoscopic technique in mitral valve surgery. Material and methods We retrospectively reviewed the profiles of 188 patients who were treated for mitral valve disease by modified totally endoscopic mitral valve surgery at our institution between January 2019 and December 2020. The procedure was performed under endoscopic right minithoracotomy and with femoro-femoral cannulation using the single two-stage venous cannula. Results A total of 188 patients underwent total endoscopic mitral valve surgery. Fifty-six patients had concomitant tricuspid valvuloplasty, 11 patients underwent concomitant ablation of atrial fibrillation and atrial septal defect repair was performed in three patients. Only one patient postoperatively died of multi-organ failure. Two patients were converted to median sternotomy. Except for one patient underwent operation to stop the bleeding from the incision site, no other serious complications nor reintervention occurred during the follow-up period. Conclusions The modified totally endoscopic mitral valve surgery performed at our institution is technically feasible and safe with the same efficacy as reported studies.

Download Full-text

Is a minimally invasive approach for mitral valve surgery more cost-effective than median sternotomy?: Table 1:

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivv269 ◽

2015 ◽

Vol 22 (1) ◽

pp. 97-100 ◽

Cited By ~ 9

Author(s):

Orlando Santana ◽

Maiteder Larrauri-Reyes ◽

Carlos Zamora ◽

Christos G. Mihos

Keyword(s):

Mitral Valve ◽

Minimally Invasive ◽

Median Sternotomy ◽

Cost Effective ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Minimally Invasive Approach ◽

Invasive Approach

Download Full-text

Minimally invasive or sternotomy approach in mitral valve surgery: a propensity-matched comparison

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01578-9 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Marek Pojar ◽

Mikita Karalko ◽

Martin Dergel ◽

Jan Vojacek

Keyword(s):

Mitral Valve ◽

Minimally Invasive ◽

Median Sternotomy ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Total Hospital Cost ◽

Minimally Invasive Approach ◽

Conventional Surgery ◽

Term Survival ◽

Invasive Approach

Abstract Objectives Conventional mitral valve surgery through median sternotomy improves long-term survival with acceptable morbidity and mortality. However, less-invasive approaches to mitral valve surgery are now increasingly employed. Whether minimally invasive mitral valve surgery is superior to conventional surgery is uncertain. Methods A retrospective analysis of patients who underwent mitral valve surgery via minithoracotomy or median sternotomy between 2012 and 2018. A propensity score-matched analysis was generated to eliminate differences in relevant preoperative risk factors between the two groups. Results Data from 525 patients were evaluated, 189 underwent minithoracotomy and 336 underwent median sternotomy. The 30 day mortality was similar between the minithoracotomy and conventional surgery groups (1 and 3%, respectively; p = 0.25). No differences were seen in the incidence of stroke (p = 1.00), surgical site infections (p = 0.09), or myocardial infarction (p = 0.23), or in total hospital cost (p = 0.48). However, the minimally invasive approach was associated with fewer patients receiving transfusions (59% versus 76% in the conventional group; p = 0.001) or requiring reoperation for bleeding (3% versus 9%, respectively; p = 0.03). There were no significant differences in 5 year survival between the minithoracotomy and conventional surgery groups (93% versus 86%, respectively; p = 0.21) and freedom from mitral valve reoperation (95% versus 94%, respectively; p = 0.79). Conclusions In patients undergoing mitral valve surgery, a minimally invasive approach is feasible, safe, and reproducible with excellent short-term outcomes; mid-term outcomes and efficacy were also seen to be comparable to conventional sternotomy.

Download Full-text

Comparison of Totally Thoracoscopic and Traditional Sternotomy Approaches for Mitral Valve Replacement

The Heart Surgery Forum ◽

10.1532/hsf.2453 ◽

2019 ◽

Vol 22 (4) ◽

pp. E310-E314

Author(s):

He Fan ◽

Qian Xi Ming ◽

Zhang Wei Min ◽

Chen Huai Dong

Keyword(s):

Cardiopulmonary Bypass ◽

Postoperative Complications ◽

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Median Sternotomy ◽

Traditional Group ◽

Thoracoscopic Approach ◽

Postoperative Drainage ◽

The Right

Background: We aimed to investigate the feasibility and safety of mitral valve replacement using a totally thoracoscopic approach in comparison with traditional median sternotomy. Methods: Between January 2016 and December 2017, 94 consecutive patients who underwent mitral valve replacement were divided into two groups: A thoracoscopic group (43 cases) and a traditional group (51 cases). For the thoracoscopic group, all patients underwent total thoracoscopic procedures with femoral arterial and venous cannulation to cardiopulmonary bypass, transthoracic aortic cross-clamp, and antegrade cardioplegia. Three intercostal ports in the right chest were used for access in the thoracoscopic group. The operation was performed completely under two-dimensional video. For the traditional group, all operations were done with traditional median sternotomy. Results: All the operations were successfully performed. The thoracoscopic group had longer aortic cross-clamping and cardiopulmonary bypass times compared with the traditional group (62.30 ± 8.17 minutes versus 44.90 ± 12.00 minutes, P < .001; 92.33 ± 12.03 minutes versus 74.22 ± 14.72 minutes, P < .001). The two groups did not show statistically significant differences with respect to operative times (184.26 ± 32.49 minutes versus 181.47 ± 23.31 minutes, P = .631). In addition, the postoperative mechanical ventilation, ICU stay, and postoperative hospital stay times and postoperative drainage were 10.14 ± 2.21 hours and 11.35 ± 2.58 hours (P = .016), 21.40 ± 3.15 hours and 29.12 ± 6.59 hours (P < .001), 8.70 ± 2.52 days and 10.04 ± 3.11 days (P = .023), and 325.71 ± 97.11 mL and 396.57 ± 121.50 mL (P < .001), respectively. Major postoperative complications occurred in three (6.98%, P = .873) cases of the thoracoscopic group. Four (7.84%) cases of the traditional group had postoperative complications. Conclusions: Despite the disadvantages such as long cross-clamp and cardiopulmonary bypass times, totally thoracoscopic mitral valve replacement is feasible and safe. More importantly, one of the principal advantages with three intercostal ports over standard sternotomy is avoiding retrosternal adhesion, thus lowering the risk of needing to redo a cardiac procedure in the future.

Download Full-text

Minimally Invasive versus Conventional Approach for Mitral Valve Surgery

QJM ◽

10.1093/qjmed/hcaa041.001 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

A B ElKerdany ◽

M A Elghanam ◽

M A Gamal ◽

T M E Abdelmoneim

Keyword(s):

Mitral Valve ◽

Minimally Invasive ◽

Mitral Valve Disease ◽

Meta Analysis ◽

Median Sternotomy ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Valve Disease ◽

Standard Approach ◽

Perioperative Outcomes

Abstract Introduction Full median sternotomy has been well established as a standard approach for all types of open heart surgery for many years. Although well established, the full sternotomy incision has been frequently criticized for its length, post operative pain and possible complications. Minimally invasive mitral valve surgery can be an appealing feasible alternative to the conventional full sternotomy approach with low perioperative morbidity and short-term mortality. We here made meta-analysis to compare perioperative outcomes of MIMVS versus CMVS in patients with mitral valve disease. Methods A systematic review of studies comparing perioperative outcomes of MIMVS versus CMVS in patients with mitral valve disease, from 2012 up to 2017. Review Manager 5.2 (Cochrane Collaboration) was employed to analyze the results. The outcomes of interest are mortality, cerebrovascular accidents, wound infection, reexploration due to bleeding, and LVEF assessment post-surgery. Results 12 studies involving 10279 patients were included in the meta-analysis. The 30-day mortality was significantly decreased with MIMVS; 1.6% in the MIMVS group and 2.9% in the group treated through a conventional sternotomy. Cerebrovascular events were significantly decreased with MIMVS; the stroke rate was 0.9% in MIMVS patients and 3% in patients treated via a conventional sternotomy. Wound infections, reexploration due to bleeding, and LVEF did not differ significantly between both groups. Conclusion The perioperative outcome is more or less similar for minimally invasive mitral valve surgery and conventional mitral valve surgery performed via median sternotomy. Given balance in outcomes, MIMVS is at least as safe as the standard approach and can be considered a routine and standard approach for mitral valve surgery.

Download Full-text

Minimally Invasive versus Conventional Mitral Valve Surgery Comparison of Early Outcomes

QJM ◽

10.1093/qjmed/hcaa042.005 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

M A Mohamed ◽

T M Elsayegh ◽

H Y Elbawab ◽

Y M Elnahas ◽

A H Omar

Keyword(s):

Mitral Valve ◽

Minimally Invasive ◽

Median Sternotomy ◽

Operation Time ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Safe Alternative ◽

Invasive Group ◽

Significant Difference ◽

The Right

Abstract The mitral valve has been traditionally approached through a median sternotomy. However, mitral valve surgery could be performed using smaller incisions including the right minithoracotomy. This study was a case-control non randomized conducted on 60 patients. All patients had isolated mitral valve disease for mitral valve surgery, 30 of them were operated through right anterolateral minithoracotomy and the others through full median sternotomy to study the effects of minimally invasive mitral valve surgery through right anterolateral minithoracotomy on morbidity and mortality compared with conventional mitral surgery. Medico legal concent was taken from all the patients in this study. All the patients completed the study and there was no mortality among the patients. There was no statistically significant difference as regards the demograohic data, NYHA score and the preoperative echocardiographic findings. Regarding intraoperative comparison, there was statistically significant difference in the cross-clamp time, total bypass time & total operation time. This difference may be due to the new experiences in this MIMVS and the lack of instrumentation that narrow the field of MIMVS. The length of the incision was highly significantly lesser in the minimally invasive group than the full sternotomy group. There was significant difference in the intensive care parameters. The blood loss and the blood transfusion required were lesser in the minimally invasive group. But the ventilation hours and ICU stay was nearly the same in both groups. There was highly significantly less postoperative pain in the minimally invasive group than in the stenotomy group. Total hospital stay was nearly the same in both groups. Minimally invasive mitral valve surgery is a safe alternative to a conventional approach and is associated with less morbidity especially with expert surgeon in simple mitral valve surgery.

Download Full-text

Minimally invasive (mini-thoracotomy) versus median sternotomy in redo mitral valve surgery: A meta-analysis of observational studies

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492321997084 ◽

2021 ◽

pp. 021849232199708

Author(s):

Azhar Hussain ◽

Jacob Chacko ◽

Mohsin Uzzaman ◽

Osama Hamid ◽

Salman Butt ◽

...

Keyword(s):

Mitral Valve ◽

Length Of Stay ◽

Minimally Invasive ◽

Hospital Mortality ◽

Observational Studies ◽

Meta Analysis ◽

Median Sternotomy ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Mini Thoracotomy

Objective Redo mitral valve surgery has traditionally been performed via a median sternotomy. It is often challenging and is associated with increased perioperative mortality. Advances in cardiac surgical techniques over the last two decades have led to an increase in the use of a minimally invasive approach via a right anterolateral mini-thoracotomy as opposed to a repeat median sternotomy. However, despite these advances, there is no general consensus on the best form of entry, and as of yet, there are no randomized controlled trials. We performed a meta-analysis of observational studies to aid in determining the best approach for redo mitral valve surgery. Method The MEDLINE and EMBASE databases were conducted up until 1 June 2020. Data regarding mortality, stroke, reoperation for bleeding and length of hospital stay, wound infection and cardiopulmonary bypass time were extracted and submitted to a meta-analysis using random effects modelling and the I2-test for heterogeneity. Seven retrospective observational studies were included, enrolling a total of 1070 patients. Results There were a total of 1070 patients. Of these 364 had non-sternotomy approach compared with 707 patients who had median sternotomy. Further subgroup analysis revealed that 327 of the 364 patients had a mini-thoracotomy approach while the remaining 37 patients had a full thoracotomy approach. In-hospital mortality and length of stay were less in non-sternotomy group compared to median sternotomy group. There were no differences in stroke, CPB time and wound infections between the two groups. Conclusion Redo mitral valve surgery can be performed safely with satisfactory outcomes via a mini-thoracotomy approach. This meta-analysis shows comparable results with reduced in-hospital mortality and hospital length of stay with a mini-thoracotomy approach.

Download Full-text