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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
Efficacy and Outcomes of Para-Annular Plication in Mitral Valve Repair via Right Mini-Thoracotomy
Kenichi Morimoto1, Shigeto Miyasaka1, Rikuto Nii1
1Cardiovascular Surgery, Tottori Prefectural Central Hospital, Tottori, JPN.
Purpose:
We aim to assess the efficacy and safety of left atrial plication (LAP), particularly para-annular plication, using a right mini-thoracotomy approach.
Methods:
Among 90 mitral valve repair (MVr) procedures performed at our institution between 2016 and 2023, 16 left atrial plication cases for left atrial enlargement (diameter: >50 mm) were assessed; nine cases underwent median sternotomy (conventional) (Group C), and seven cases underwent minimally invasive cardiac surgery (MICS) (Group M). The surgical protocol involved mitral valve repair via a right-sided left atrial approach, incorporating para-annular plication to suture the posterior wall. The mean follow-up duration was 3.3±2.4 years.
Results:
Mortality within 30 days of surgery or during hospitalization did not occur. Postoperative complications included one case in each group that required reoperation for hemorrhage originating extraneously in the left atrium. Postoperative echocardiographic assessments revealed a comparable reduction in left atrial diameter (C/M: 80.3±7.0/80.7±14.6%; p=0.94), left atrial volume index (55.6±19.3/68.3±34.1%; p=0.36), and aorto-mitral angle (AMA) enlargement (113.8±7.3/107.5±12.2%; p=0.22). The three-year survival rate (88.9%/75.0%; p=0.33) was comparable between groups.
Conclusion:
The synergistic utilization of left atrial plication with para-annular plication via right mini-thoracotomy can enhance the postoperative outcomes of mitral valve repair.
Insights
Left atrial plication (LAP) with para-annular plication via right mini-thoracotomy is safe and effective for mitral valve repair. This minimally invasive approach shows comparable outcomes to conventional sternotomy for enlarged left atria.
Area of Science:
- Cardiac Surgery
- Minimally Invasive Cardiac Surgery
- Mitral Valve Repair
Background:
- Left atrial enlargement is a common complication of mitral valve disease.
- Surgical correction of mitral valve issues often requires addressing left atrial size.
- Para-annular plication is a technique used to reduce left atrial dimensions.
Purpose of the Study:
- To evaluate the efficacy and safety of left atrial plication (LAP), specifically para-annular plication.
- To assess the outcomes of LAP performed via a right mini-thoracotomy approach for mitral valve repair.
Main Methods:
- Retrospective analysis of 16 patients undergoing mitral valve repair with LAP for left atrial enlargement (>50 mm).
- Comparison between conventional median sternotomy (9 patients) and minimally invasive cardiac surgery (MICS) via right mini-thoracotomy (7 patients).
- Surgical protocol included mitral valve repair with para-annular plication; mean follow-up of 3.3 years.
Main Results:
- No 30-day or in-hospital mortality observed.
- Comparable reduction in left atrial diameter, volume index, and aorto-mitral angle between groups.
- Similar three-year survival rates (88.9% conventional vs. 75.0% MICS) and complication rates (one reoperation for hemorrhage in each group).
Conclusions:
- Left atrial plication, particularly para-annular plication, is a safe and effective adjunct to mitral valve repair.
- The right mini-thoracotomy approach for LAP offers comparable outcomes to conventional sternotomy.
- This technique can improve postoperative results in patients with enlarged left atria undergoing mitral valve repair.
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