Evolution of morphological and functional parameters of the right ventricle after mitral valve surgery

Abstract OBJECTIVES Totally endoscopic aortic valve replacement (AVR) is still a challenging operation, and only a few series reports exist in the literature. The purposes of this study were to establish a method for endoscopic AVR and evaluate its initial results. METHODS A total of 47 patients (median age 76 years, 17 men) underwent endoscopic AVR. The main wound was created in the right anterolateral 4th intercostal space through a 4-cm skin incision. No rib spreader was used. A 3-dimensional endoscope was inserted at the midaxillary line. A 5.5-mm trocar was inserted in the 3rd intercostal space, thus creating a 3-port setting similar to that used for endoscopic mitral valve surgery. A standard prosthesis was used, and the sutures were tied using a knot pusher. Results were compared with those of 157 patients who underwent right transaxillary AVR with direct vision plus endoscopic assist. RESULTS Patient backgrounds did not differ significantly between the 2 groups. No deaths occurred in the entire series. There was no conversion to thoracotomy or sternotomy in the endoscopic AVR group. The complication rate did not differ significantly between the 2 groups. The total operating time was significantly shorter in endoscopic AVR (188–206 min); the cardiopulmonary bypass time (130–128 min) and the cross-clamp time (90–95 min) did not differ significantly (median, endoscopic AVR, right transaxillary AVR). Two patients underwent endoscopic double-valve (aortic and mitral) surgery under the same conditions. CONCLUSIONS Endoscopic AVR was possible through 3 ports created in the right anterolateral chest, similar to the procedure for endoscopic mitral valve surgery. By adopting a common approach for both the aortic and the mitral valve operations, endoscopic double-valve surgery can be performed seamlessly.

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Localized Pulmonary Edema in the Middle and Inferior Lobes of the Right Lung after One-lung Ventilation for Minimally Invasive Mitral Valve Surgery

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2014.04.006 ◽

2015 ◽

Vol 29 (4) ◽

pp. 1009-1012 ◽

Cited By ~ 2

Author(s):

Nobuko Fujita ◽

Kiyoyuki Miyasaka ◽

Osamu Okada ◽

Masao Katayama ◽

Katsuyuki Miyasaka

Keyword(s):

Mitral Valve ◽

Minimally Invasive ◽

Pulmonary Edema ◽

Lung Ventilation ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

One Lung Ventilation ◽

The Right

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Mild to Moderate Functional Tricuspid Regurgitation: Retrospective Comparison of Surgical and Conservative Treatment

Cardiology Research and Practice ◽

10.4061/2010/143878 ◽

2010 ◽

Vol 2010 ◽

pp. 1-5 ◽

Cited By ~ 4

Author(s):

Michal Šmíd ◽

Jakub Čech ◽

Richard Rokyta ◽

Patrik Roučka ◽

Tomáš Hájek

Keyword(s):

Mitral Valve ◽

Right Ventricle ◽

Tricuspid Regurgitation ◽

Systolic Dysfunction ◽

Mitral Valve Surgery ◽

Functional Tricuspid Regurgitation ◽

Retrospective Comparison ◽

Near Term ◽

The Right ◽

And Function

Background. Unoperated severe tricuspid regurgitation (TR) leads to the right ventricle (RV) failure. We wanted to determine if there was near-term postoperative progression of noncorrected mild to moderate functional TR in patients who underwent mitral valve surgery for chronic significant mitral regurgitation (MR) and if RV size and function were affected.Methods and Results. We compared two groups of patients retrospectively. In the first group (TVA+, ), tricuspid valve annuloplasty (TVA) had been performed in conjunction with either mitral valve replacement (MVR) or mitral valve repair (MVP). The second group (TVA−, ) underwent MVP or MVR without TVA. TVA+ group revealed a significant decrease in TR and right ventricle diameter. In the TVA− group, 7 patients (32%) showed a significant progression, by one or more grades, of noncorrected TR together with dilatation and decreased ejection fraction of the right ventricle.Conclusions. Tricuspid annuloplasty performed concurrently with MVP or MVR can prevent subsequent progression of tricuspid regurgitation along with right ventricular dilatation and systolic dysfunction in the near-term postoperative period.

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P3678Pulmonary artery ablation during open mitral valve surgery for pulmonary artery hypertension: a prospective randomized study

European Heart Journal ◽

10.1093/eurheartj/ehz745.0533 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

A V Bogachev-Prokophiev ◽

A Zalesov ◽

A V Afanasyev ◽

R M Sharifulin ◽

M A Ovcharov ◽

...

Keyword(s):

Mitral Valve ◽

Pulmonary Artery ◽

Functional Capacity ◽

Mitral Valve Disease ◽

Pulmonary Artery Hypertension ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Valve Disease ◽

Open Heart ◽

The Right

Abstract Purpose Recent investigations of pulmonary artery (PA) ablation into the treatment of idiopathic pulmonary artery hypertension (PAH) have suggested improvement of functional capacity, and hemodynamics. We investigated the impact of PA ablation in patients with PAH due to left heart disease (Dana Point, 2008) scheduled for open-heart mitral valve surgery. Methods Fifty patients aged 52±10 with mitral valve disease complicated severe PAH (mean PAP >40mm Hg) were randomly assigned to mitral valve surgery with or without PA ablation procedure. Eligible criteria: positive reactive test with nitric oxide inhalation (decrease of mean PAP more than 10 mm Hg without decrease of cardiac output). There were no between group differences in preoperative characteristics. Surgical procedure After bypass is establishedthe fibrous fold of pericardiumand the ligamentum arteriosum are dissected out, and the branches of the right and left pulmonary artery are mobilized well out into the hilum of the lungs bilaterally. PA ablation was performed epicardially at the bifurcation of the main PA, and 10 mm distal to the right and left PA's using AtriCure Isolator®multifunctional pen. Serial assessment of echocardiography, right heart catheterization (catheter Swan-Ganz), and 6-min walk test (6MWT) were performed during hospital stay. The primary endpoints were the change of meanpulmonary artery pressure (PAP)and 6MWT. The secondary endpoints were hospital mortality, freedom from PADN-related complication: PA perforation, PA dissection, and PA thrombosis (MDCT assessment). Results There were no early deaths. No procedure-related complications were observed. On first day after surgery patients from ablation group showed significant reduction of mean PAP (from 50.6±5.3to 34.6±9.9 mm Hg, p<0.001), and significant improvement of 6MWT at discharge (from 229±34 m to 475±21 m, p<0.001). On first day after surgery patients from control group also showed significant reduction of mean PAP (from 51.3±6.3to 47.2±8.5 mm Hg, p=0.011), and significant improvement of 6MWT at discharge (from 249±32 m to 335±18 m, p<0.001). Nevertheless, there was significant between group difference in mean PAP on first day after surgery (34.6±9.9 mm Hg, vs 47.2±8.5 mm Hg, p=0.005). Moreover there was significant differences in 6MWT at discharge (475±21 m vs 335±18 m, p=0.002) with benefit to ablation group. Epicardial pulmonary artery ablation Conclusions We report for the first time the effect and superiority of PA ablation on functional capacity and hemodynamics in patients with mitral valve disease complicated PAH. Epicardial PA ablation for the treatment PAH can be effectively and safely performed during open heart surgery. Acknowledgement/Funding None

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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.

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RF72 RIGHT VENTRICLE EVALUATION BY CARDIAC MAGNETIC RESONANCE BEFORE AND AFTER MITRAL VALVE SURGERY

Journal of Cardiovascular Medicine ◽

10.2459/01.jcm.0000550011.88872.fe ◽

2018 ◽

Vol 19 ◽

pp. e54

Author(s):

M. Pettinari ◽

S. Lazam ◽

L. De Kerchove ◽

A. Pasquet ◽

B. Gerber ◽

...

Keyword(s):

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Mitral Valve ◽

Right Ventricle ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Before And After

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Intercostal Space Prediction Using Deep Learning In Fully Endoscopic Mitral Valve Surgery

10.1101/710996 ◽

2019 ◽

Author(s):

Rafik Margaryan ◽

Daniele Della Latta ◽

Giacomo Bianchi ◽

Nicola Martini ◽

Gianmarco Santini ◽

...

Keyword(s):

Neural Network ◽

Deep Learning ◽

Random Forest ◽

Mitral Valve ◽

Clinical Data ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Intercostal Space ◽

X Rays ◽

The Right

AbstractObjectiveAbout 10 million people in Europe suffer from mitral valve incompetence. Majority of these entity is mitral valve prolapse in developed countries. Endoscopic mitral valve surgery is a relatively new procedure and preparation in the right intercostal space are crucial for success completion of the procedure. We aimed to explore clinical variables and chest X-rays in order to build most performant model that can predict the right intercostal space for thoracotomy.MethodsOverall 234 patients underwent fully endoscopic mitral valve surgery. All patients had preoperative two projection radiography. Intercostal space for right thoracotomy was decided by expert cardiac surgeons taking in consideration the height, weight, chest radiography, anatomical position of skin incision, nipple position and the sex. In order to predict the right intercostal space we have used clinical data and we have collected all radiographies and feed it to deep neural network algorithm. We have spitted the whole data-set into two subsets: training and testing data-sets. We have used clinical data and build an algorithm (Random Forest) in order to have reference model.ResultsThe best-performing classifier was GoogLeNet neural network (now on we will reffera as Deep Learning) and had an AUC of 0.956. Algorithm based on clinical data (Random Forest) had AUC of 0.529 using only chest x-rays. The deep leaning algorithm predicted correctly in all cases the correct intercostal space on the training datasest except two ladies (96.08% ; with sensitivity of 97.06% and specificity 94.12 %, where the Random Forest was capable to predict right intercostal space in 60.78% cases with sensitivity of 93.33% and specificity 14.29 % (only clinical data).ConclusionArtificial intelligence can be helpful to program the minimally invasive cardiac operation, for right intercostal space selection for thoracotomy, especially in non optimal thoraxes (example, obese short ladies). It learned from the standard imaging (thorax x-ray) which is easy, do routinely to every patient.

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