Right minithoracotomy versus conventional median sternotomy for patients undergoing mitral valve surgery and Cox-maze IV ablation with entirely bipolar radiofrequency clamp

2018 ◽  
Vol 33 (8) ◽  
pp. 901-907
Author(s):  
Zhaolei Jiang ◽  
Min Tang ◽  
Nan Ma ◽  
Hao Liu ◽  
Fangbao Ding ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Median Sternotomy ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Bipolar Radiofrequency

scholarly journals Totally endoscopic mitral valve surgery: early experience in 188 patients

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Yi Chen ◽  
Ling-chen Huang ◽  
Dao-zhong Chen ◽  
Liang-wan Chen ◽  
Zi-he Zheng ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Minimally Invasive ◽  
Mitral Valve Disease ◽  
Median Sternotomy ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Valve Disease ◽  
Endoscopic Technique ◽  
Venous Cannula ◽  
Defect Repair

Abstract Introduction Totally endoscopic technique has been widely used in cardiac surgery, and minimally invasive totally endoscopic mitral valve surgery has been developed as an alternative to median sternotomy for many patients with mitral valve disease. In this study, we describe our experience about a modified minimally invasive totally endoscopic mitral valve surgery and reported the preliminary results of totally endoscopic mitral valve surgery. The aim of this retrospective study is to evaluate the results of totally endoscopic technique in mitral valve surgery. Material and methods We retrospectively reviewed the profiles of 188 patients who were treated for mitral valve disease by modified totally endoscopic mitral valve surgery at our institution between January 2019 and December 2020. The procedure was performed under endoscopic right minithoracotomy and with femoro-femoral cannulation using the single two-stage venous cannula. Results A total of 188 patients underwent total endoscopic mitral valve surgery. Fifty-six patients had concomitant tricuspid valvuloplasty, 11 patients underwent concomitant ablation of atrial fibrillation and atrial septal defect repair was performed in three patients. Only one patient postoperatively died of multi-organ failure. Two patients were converted to median sternotomy. Except for one patient underwent operation to stop the bleeding from the incision site, no other serious complications nor reintervention occurred during the follow-up period. Conclusions The modified totally endoscopic mitral valve surgery performed at our institution is technically feasible and safe with the same efficacy as reported studies.

scholarly journals Bipolar versus unipolar energy in the surgical ablation of atrial fibrillation in patients with mitral valve surgery

2018 ◽  
Vol 2 (Issue 4) ◽  
pp. 106
Author(s):  
Leonardo Canale ◽  
Bruno Azevedo ◽  
Marcelo Goulart Correia ◽  
Ernesto Chavez ◽  
Erica Macedo ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Mitral Valve ◽  
Sinus Rhythm ◽  
Valve Replacement ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Left Ventricular Ejection ◽  
Surgical Ablation ◽  
Bipolar Radiofrequency ◽  
Bipolar Energy

Objective: To evaluate the presence of sinus rhythm or atrial fibrillation (AF) in patients who had mitral valve surgery with concomitant surgical ablation of AF, by unipolar or bipolar radiofrequency. Methods: Adults patients who had mitral valve replacement or mitral valvuloplasty with concomitant surgical ablation of AF, either by unipolar or bipolar radiofrequency, were consecutively included between the 2008 and 2012. Surgery was done by conventional median sternotomy. Results: A total of 99 patients were included; 20 (20.2%) had surgical ablation by unipolar energy and 79 (79.8%) by bipolar energy. There were 76 (76.8%) women, and mean age± SD was 51 ±11 years.  The median duration of AF before surgery was 41 months. Type of AF was paroxysmal in 21 (21%), persistent in 11 (11%), and long-standing persistent in 67 (67%). Mean left atrium size in the preoperative period was 5.54 ± 0.82 cm. Mean left ventricular ejection fraction was 58±12.4%. Types of mitral valve surgery were valvuloplasty (n=10), mechanical valve replacement in 30, and bioprosthesis replacement in 59. Concomitant tricuspid annuloplasty was performed in 39 patients. Thirty- day mortality was 8/99 (8%). Mean follow-up time was 1274 days (3.49 years). Survival was 92%. After 4 years no patient who had had unipolar ablation was in sinus rhythm, whilst 67% of those who had bipolar energy ablation were in sinus rhythm (p<0.001). Conclusion: The use of bipolar energy is superior to unipolar energy in the surgical ablation of atrial fibrillation in patients submitted to mitral valve surgery.

scholarly journals Health-Related Quality of Life following Minimally Invasive Totally Thoracoscopic Mitral Valve Surgery

2020 ◽  
Author(s):  
Ling-chen Huang ◽  
Dao-zhong Chen ◽  
Liang-wan Chen ◽  
Qi-chen Xu ◽  
Zi-he Zheng ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Pain Intensity ◽  
Rating Scale ◽  
Median Sternotomy ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Thoracoscopic Approach ◽  
Aesthetic Appearance ◽  
Related Quality ◽  
Health Related

Abstract Background In order to compare the impact of two different approaches to mitral valve surgery on health-related quality of life, we conducted a retrospective study comparing minimally invasive totally thoracoscopic mitral valve surgery with median sternotomy mitral valve surgery. Methods A total of 163 patients who underwent mitral valve surgery at our institution between January 1, 2019 and December 31, 2019 were enrolled. In 163 patients, mitral valve surgery was performed using either totally thoracoscopic approach (TA n = 78) or median sternotomy approach (SA n = 85). We used the Scar Cosmesis Assessment and Rating Scale and the Numerical Rating Scale to measure the pain intensity and the aesthetic appearance of surgical incision and used the MOS SF-36 to assess the HRQoL. Results The two groups of patients were similar in terms of demographic, echocardiography data and postoperative complications. The pain intensity and aesthetic appearance of the totally thoracoscopic approach were significantly better than that of the median sternotomy approach. Significant differences in the subscale of the SF-36 were found between the two groups. Conclusions When compared to the median sternotomy mitral valve surgery, totally thoracoscopic mitral valve surgery has an equally good outcome, while improving aesthetic appearance and reducing pain intensity. Our study suggested that totally thoracoscopic approach is superior to median sternotomy approach in terms of pain intensity, aesthetic appearance and HRQoL.

Surgical antegrade transcatheter valve implantation and heavily calcified heart

2018 ◽  
Vol 26 (6) ◽  
pp. 470-472
Author(s):  
Elise Lupon ◽  
Anais Lemaire ◽  
Christophe Cron ◽  
Bertrand Marcheix
Keyword(s):  
Mitral Valve ◽  
Heart Surgery ◽  
Median Sternotomy ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Left Heart ◽  
Mitral Orifice ◽  
Transcatheter Valve ◽  
Valve Implantation ◽  
Severe Calcification

It is well known that a heavily calcified mitral valve significantly increases the perioperative and postoperative risks of mitral valve surgery. A 71-year-old woman was referred to our department with severe mitral valve disease. Cardiac imaging revealed extremely severe calcification of the entire left heart. Surgery was performed through a median sternotomy with standard cardiopulmonary bypass. After dilating the mitral orifice with a balloon, we replaced the valve with a transcatheter Edwards Sapiens 3 aortic valve under direct vision. Seven months after the procedure, the patient was doing well and no longer suffered from dyspnea.

scholarly journals Minimally invasive or sternotomy approach in mitral valve surgery: a propensity-matched comparison

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Marek Pojar ◽  
Mikita Karalko ◽  
Martin Dergel ◽  
Jan Vojacek
Keyword(s):  
Mitral Valve ◽  
Minimally Invasive ◽  
Median Sternotomy ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Total Hospital Cost ◽  
Minimally Invasive Approach ◽  
Conventional Surgery ◽  
Term Survival ◽  
Invasive Approach

Abstract Objectives Conventional mitral valve surgery through median sternotomy improves long-term survival with acceptable morbidity and mortality. However, less-invasive approaches to mitral valve surgery are now increasingly employed. Whether minimally invasive mitral valve surgery is superior to conventional surgery is uncertain. Methods A retrospective analysis of patients who underwent mitral valve surgery via minithoracotomy or median sternotomy between 2012 and 2018. A propensity score-matched analysis was generated to eliminate differences in relevant preoperative risk factors between the two groups. Results Data from 525 patients were evaluated, 189 underwent minithoracotomy and 336 underwent median sternotomy. The 30 day mortality was similar between the minithoracotomy and conventional surgery groups (1 and 3%, respectively; p = 0.25). No differences were seen in the incidence of stroke (p = 1.00), surgical site infections (p = 0.09), or myocardial infarction (p = 0.23), or in total hospital cost (p = 0.48). However, the minimally invasive approach was associated with fewer patients receiving transfusions (59% versus 76% in the conventional group; p = 0.001) or requiring reoperation for bleeding (3% versus 9%, respectively; p = 0.03). There were no significant differences in 5 year survival between the minithoracotomy and conventional surgery groups (93% versus 86%, respectively; p = 0.21) and freedom from mitral valve reoperation (95% versus 94%, respectively; p = 0.79). Conclusions In patients undergoing mitral valve surgery, a minimally invasive approach is feasible, safe, and reproducible with excellent short-term outcomes; mid-term outcomes and efficacy were also seen to be comparable to conventional sternotomy.

scholarly journals Minimally Invasive versus Conventional Approach for Mitral Valve Surgery

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A B ElKerdany ◽  
M A Elghanam ◽  
M A Gamal ◽  
T M E Abdelmoneim
Keyword(s):  
Mitral Valve ◽  
Minimally Invasive ◽  
Mitral Valve Disease ◽  
Meta Analysis ◽  
Median Sternotomy ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Valve Disease ◽  
Standard Approach ◽  
Perioperative Outcomes

Abstract Introduction Full median sternotomy has been well established as a standard approach for all types of open heart surgery for many years. Although well established, the full sternotomy incision has been frequently criticized for its length, post operative pain and possible complications. Minimally invasive mitral valve surgery can be an appealing feasible alternative to the conventional full sternotomy approach with low perioperative morbidity and short-term mortality. We here made meta-analysis to compare perioperative outcomes of MIMVS versus CMVS in patients with mitral valve disease. Methods A systematic review of studies comparing perioperative outcomes of MIMVS versus CMVS in patients with mitral valve disease, from 2012 up to 2017. Review Manager 5.2 (Cochrane Collaboration) was employed to analyze the results. The outcomes of interest are mortality, cerebrovascular accidents, wound infection, reexploration due to bleeding, and LVEF assessment post-surgery. Results 12 studies involving 10279 patients were included in the meta-analysis. The 30-day mortality was significantly decreased with MIMVS; 1.6% in the MIMVS group and 2.9% in the group treated through a conventional sternotomy. Cerebrovascular events were significantly decreased with MIMVS; the stroke rate was 0.9% in MIMVS patients and 3% in patients treated via a conventional sternotomy. Wound infections, reexploration due to bleeding, and LVEF did not differ significantly between both groups. Conclusion The perioperative outcome is more or less similar for minimally invasive mitral valve surgery and conventional mitral valve surgery performed via median sternotomy. Given balance in outcomes, MIMVS is at least as safe as the standard approach and can be considered a routine and standard approach for mitral valve surgery.

scholarly journals Early clinical outcome after right anterolateral thoracotomy as an alternative for median sternotomy for mitral valve replacement

2020 ◽  
Vol 2 (2) ◽  
pp. 47-54
Author(s):  
Ahmed Rady Attallah ◽  
Shady Eid Al-Elwany ◽  
Mohammed A.K. Salama Ayyad ◽  
Ali Mohammed Abdelwahab
Keyword(s):  
Mitral Valve ◽  
Blood Transfusion ◽  
Clinical Outcome ◽  
Blood Loss ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Median Sternotomy ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Anterolateral Thoracotomy

Background: The advantages of the right anterolateral thoracotomy (RALT) approach for mitral valve surgery over standard median sternotomy (MS) are still debatable. The objective of this study was to evaluate and compare the postoperative clinical outcome after RALT and MS for mitral valve replacement. Methods: This prospective observational study included 40 patients who underwent mitral valve replacement between January 2016 and August 2018. Patients were assigned to two groups, the first group included 20 patients who had conventional median sternotomy approach and the second group included 20 patients who had right anterolateral thoracotomy with the complete cannulation and aortic cross-clamping conducted through the same incision. Results: In comparison to MS, RALT had significantly higher cross-clamp time (77.7±16.1 vs 45.8±8.7 minutes, P < 0.01), total bypass time (105.2±12.7 vs 72.2±10.4 minutes, P < 0.01), and total operative time (287±41 vs 231±36 min, P < 0.01), in addition to significantly lower ventilation time (4.2±1.51 vs 6.1±1.84 hours, P < 0.01), blood loss (229±85 vs 335±137 ml), amount of blood transfusion (1.41±0.6 vs 2.19±1.1 units, P < 0.01), ICU stay duration (2.11±0.49 vs 2.78±0.82 days, P < 0.01), pain scores at 1st and 2nd postoperative days (5.67±0.79 vs 7.81±0.53, p < 0.01), and total hospital stay duration (7.2±1.3 vs 8.4±1.6 days, P = 0.01). Patients' satisfaction about their wound was significantly higher in RALT group compared to MS group (95% vs 30%, P < 0.01). Conclusion: The RALT approach for mitral valve surgery could be a safe and effective approach when compared to median sternotomy. RALT could be associated with a reduction of blood loss, blood transfusion, wound infection, in addition to shorter ICU and hospital stay.

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