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Minimally invasive beating heart technique for mitral valve surgery in patients with previous sternotomy and giant

Hang Zhang1, Hua-Shan Xu2, Bing Wen2

  • 1Department of Cardiovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China. hang8322@163.com.

Journal of Cardiothoracic Surgery
|June 5, 2020
PubMed

Insights

Minimally invasive beating heart mitral valve surgery is effective for patients with prior sternotomy and giant left ventricles. This technique reduces operation time, blood loss, and hospital stay compared to conventional methods.

Area of Science:

  • Cardiovascular Surgery
  • Minimally Invasive Cardiac Surgery
  • Mitral Valve Repair and Replacement

Background:

  • Previous sternotomy and giant left ventricles (LVEDD ≥70 mm) present unique challenges in mitral valve surgery.
  • Conventional median resternotomy with arrested heart technique carries significant risks and recovery burdens for these patients.

Purpose of the Study:

  • To evaluate the efficacy and outcomes of the minimally invasive beating heart technique for mitral valve surgery.
  • To compare the minimally invasive beating heart technique with the conventional median resternotomy arrested heart technique in patients with prior sternotomy and giant left ventricles.

Main Methods:

  • A retrospective analysis of 80 cardiac patients with previous sternotomy and giant left ventricles who underwent mitral valve surgery between January 2006 and January 2019.
  • Patients were divided into two groups: minimally invasive beating heart technique (n=30) and conventional median resternotomy arrested heart technique (n=50).
  • Preoperative, intraoperative, and postoperative variables were compared between the two groups.

Main Results:

  • The minimally invasive beating heart technique group showed significantly shorter operation times, cardiopulmonary bypass (CPB) times, intraoperative blood loss, and postoperative transfusion requirements compared to the conventional group.
  • Patients undergoing the minimally invasive technique had reduced extubation times, intensive care unit (ICU) stays, and overall hospital stays.
  • No significant differences were observed in re-exploration for bleeding, 30-day mortality, postoperative complications, or 6-month echocardiographic parameters between the groups.

Conclusions:

  • The minimally invasive beating heart technique is an effective and reliable approach for mitral valve surgery in patients with previous sternotomy and giant left ventricles.
  • This technique offers significant advantages, including reduced operative time, decreased blood loss and transfusion needs, and shorter recovery periods.
  • The findings support the minimally invasive beating heart technique as a beneficial alternative to conventional sternotomy for selected cardiac patients.
Abstract

Keywords:
Beating heart techniqueGiant left ventricleMinimally invasivePrevious sternotomyRedo mitral valve surgery

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