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Less invasive techniques for mitral valve surgery
D F Loulmet1, A Carpentier, P W Cho
1Department of Cardiovascular Surgery and Organ Transplantation, Hôpital Broussais, University of Paris, France.
Objective:
Minimally invasive surgical techniques aim at reducing the consequences of currently used large incisions, such as bleeding, pain, and risk of infection. Although this new approach developed rapidly in coronary surgery, it remains questionable in mitral valve surgery. This article reports the longest experience with minimally invasive mitral valve surgery, with particular attention to approach and techniques.
Methods:
From February 1996, the date of the first case of minimally invasive mitral valve reconstruction, to April 1997, 22 patients with a mean age of 54 +/- 2.7 years were subjected to mitral valve surgery performed with less invasive techniques. Exposure of the mitral valve was achieved through a minithoracotomy (n = 12) or a ministernotomy (n = 10). Video assistance was used in all cases. Peripheral arterial cannulation (n = 21) and venous drainage (n = 22) were used in most cases.
Results:
In this series, valve surgery consisted in 19 repairs, two replacements, and one closure of a periprosthetic leak. In two cases it was necessary to convert to a larger incision. The average duration of cardiopulmonary bypass was 157 +/- 8.2 minutes, ventilatory assistance 16 +/- 4.6 hours, and intensive care unit stay 2.1 +/- 0.4 days. Two patients required reoperation for bleeding and another for early recurrence of mitral valve regurgitation. There were no deaths and all patients were discharged with normal valve function. At most recent follow-up, all patients were in functional class I, with resumption of normal activity.
Conclusion:
Mitral valve surgery can be performed safely by means of less invasive techniques, but with increased technical difficulty. A low asymmetric median sternotomy seems preferable to an anterior thoracotomy.
Insights
Minimally invasive mitral valve surgery is safe and effective, offering good outcomes. A low asymmetric median sternotomy approach is recommended over anterior thoracotomy for improved results.
Area of Science:
- Cardiac Surgery
- Minimally Invasive Techniques
- Valvular Heart Disease
Background:
- Minimally invasive surgery aims to reduce complications from large incisions.
- While advanced in coronary surgery, its application in mitral valve surgery is less established.
- This study presents extensive experience with minimally invasive mitral valve surgery, focusing on techniques and approaches.
Purpose of the Study:
- To evaluate the safety and efficacy of minimally invasive mitral valve surgery.
- To report the longest experience with this surgical approach.
- To compare different minimally invasive techniques for mitral valve surgery.
Main Methods:
- Twenty-two patients underwent minimally invasive mitral valve surgery between February 1996 and April 1997.
- Surgical access was achieved via minithoracotomy (12 patients) or ministernotomy (10 patients).
- Video assistance, peripheral arterial cannulation, and venous drainage were utilized in most cases.
Main Results:
- The procedures included 19 mitral valve repairs, 2 replacements, and 1 periprosthetic leak closure.
- Conversion to a larger incision was necessary in two cases.
- Average cardiopulmonary bypass time was 157 minutes; average ventilatory support was 16 hours; ICU stay averaged 2.1 days.
Conclusions:
- Mitral valve surgery can be performed safely using less invasive techniques, despite increased technical challenges.
- A low asymmetric median sternotomy is suggested as a preferable approach compared to anterior thoracotomy.
- All patients achieved normal valve function and returned to normal activities post-surgery.