Techniques and results of direct-access minimally invasive mitral valve surgery: a paradigm for the future.
ABSTRACT Our objective was to determine whether direct-access minimally invasive mitral valve surgery can improve recovery and cost while maintaining the efficacy of conventional surgery.
Minimally invasive mitral valve operations were performed on 106 patients, 58% male, average age 58.1 years, with good ventricular function. Ninety underwent repair of a regurgitant, myxomatous valve, and 16 underwent mitral valvuloplasty for prematurely calcified mitral stenosis. The valve was approached with standard instruments through a 5- to 8-cm right parasternal incision. Eighty-five had open femoral artery-femoral vein cannulation, but this technique has recently been replaced by direct cannulation of the aorta and percutaneous cannulation of the femoral vein for most patients.
There were no operative deaths. The mean mitral regurgitation score (0-4) decreased from 3.7 to 0.7 after the operation. Although ischemic and bypass times were increased, postoperative recovery was accelerated. Ventilatory support time, intensive care unit stay, hospital stay, need for rehabilitation, and return to "normal activities" all improved. Hospital charges, pain medications, and blood transfusions were also reduced. New atrial fibrillation contributed significantly to increased length of stay and charges. There were no deep wound infections. Other complications included re-exploration for bleeding (n = 1), transient ischemic attacks (n = 2), stroke (n = 1), femoral artery injury (n = 5), pseudoaneurysm (n = 2), and antegrade dissection of the ascending aorta (n = 1). Two patients died and 1 required reoperation during a mean follow-up of 8.8 months.
Direct-access minimally invasive mitral valve surgery can accelerate recovery, decrease charges, and decrease pain, while maintaining overall surgical efficacy. It has become our standard approach for isolated primary mitral valve operations.
- SourceAvailable from: ahajournals.orgCirculation 06/1999; 99(20):2613. · 15.20 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Minimally invasive cardiac surgery has been performed in major worldwide centers, including procedure such as valves, coronary and congenital surgery. To demonstrate our first works with noninvasive cardiac surgery by mean of the experience gained with general and thoracic surgery. Whenever possible to carry out a minimally invasive cardiac surgery, this was the approach of choice. The left thoracoscopy was used in four cases: (1) symptomatic coronary-pulmonary fistula ligation; (2) implant of an epicardial electrode into the left ventricle for resynchronization; (3) excision of pericardial giant lipoma in the left atrium, and (4) resection of hemangiolipoma in the mediastinum. Right thoracoscopy with extracorporeal circulation through cardiopulmonary bypass via femoral vein and artery and cardiac arrest in ventricular fibrillation with moderate hypothermia were carried out in the following cases: (5) patient with mitral stenosis after surgical repair with Carpentier ring 12 years before. An anterior and posterior commissurotomy without thoracotomy was successfully made; (6) patient with idiopathic dilated cardiomyopathy, high-response atrial fibrillation, and severe mitral insufficiency, underwent mitral repair surgery with Gregori's ring and ablation of the pulmonary veins with radio-frequency catheter. (MAZZE modified). No death occurred in this series and the surgical result in all cases was highly satisfactory. All patients were discharged from hospital with a mean time of 5.5 +/- 5 days after intervention. Our initial experience in this field proves the effectiveness and the viability in introducing this type of technique.Brazilian Journal of Cardiovascular Surgery 07/2008; 23(2):183-9.
- [Show abstract] [Hide abstract]
ABSTRACT: Background Cardiac Surgery has evolved over past 50 years and has become a mature discipline. Minimally Invasive Cardiac Surgery techniques (MICS), warmly welcomed in the developed world, are still to take root in the developing countries. Minimally invasive approach represents a challenge in that it requires a new learning curve and carries apprehension about compromising the surgical results. As for the established surgeon, MICS necessitates a departure from the comfort zone and considerable metamorphosis. Methods Cardiac surgery has been carried at our centre for nearly two decades. Completing first year of our minimally invasive program we did 70 cardiac surgical cases from June 2011 to August 2012. These included 25 Mitral Valve Replacements (MVR), 30 Atrial Septal Defect closures (ASD), 10 Aortic Valve Replacement(AVR) and 5 Coronary Artery Bypass Grafting (CABG). Results There was no peri-op mortality. There were 2 conversions to standard sternotomy both in the early part of our learning curve. One patient developed right lower limb edema related to femoral vein cannulation.10 patients had minor air leak which settled spontaneously. There was one incidence of deep surgical site infection. The mean cross clamp time for ASD closure, MVR and AVR were 26.13 min, 51.10 min and 58.66 min respectively. The median Intensive Care Unit (ICU) stay was 2 days and the median hospital stay was 4 days. Conclusion The Cardiac surgery stage in the developing countries is ripe for the era of MICS. The unique patient population here stands to benefit most from it. Careful patient selection aiming to “tailor the operation to the patient and not the patient to the operation” is the crux of a successful MICS program.Indian Journal of Thoracic and Cardiovascular Surgery 01/2013; 29(2).