Right Minithoraсotomy as a Standard Approach for Mitral Valve Surgery

  • O. D. Babliak Cardiosurgery Center of Dobrobut Health Care Network, Kyiv, Ukraine
  • V. M. Demianenko Cardiosurgery Center of Dobrobut Health Care Network, Kyiv, Ukraine
  • D. Y. Babliak Cardiosurgery Center of Dobrobut Health Care Network, Kyiv, Ukraine
  • A. I. Marchenko Cardiosurgery Center of Dobrobut Health Care Network, Kyiv, Ukraine
  • K. A. Revenko Cardiosurgery Center of Dobrobut Health Care Network, Kyiv, Ukraine
  • L. V. Pidgaina Cardiosurgery Center of Dobrobut Health Care Network, Kyiv, Ukraine
Keywords: minimally invasive cardiac surgery, mitral valve surgery

Abstract

Background. Minimally invasive mitral valve surgery provides many advantages for patients.

The aim. To investigate and represent our own experience in minimally invasive mitral valve surgery, and to describe the operative technique.

Materials and methods. The study was included 100 consecutive patients who underwent a minimally invasive mitral valve repair or replacement through the right lateral minithoracotomy from June 2017 to December 2019.

Results. Mitral valve repair was performed in 87 patients (87%), and 13 patients (13%) were required mitral valve replacement. In 24 patients (24%), concomitant procedures were performed: tricuspid valve repair, atrial septal defect repair and left atrial myxomectomy. Ring anuloplasty was performed in all patients who underwent mitral valve repair. Additional methods of correction were used in accordance to the lesion anatomy: neochords implantation, cleft and leaflet perforation closure, leaflet resection, Alfieri (edge-to-edge) stitch, posterior leaflet plication. There was no in-hospital and 30-day mortality. Post-operative strokes were not reported. No wound complications were observed in the femoral cannulation area. The total length of stay in a hospital was 6 ± 1.46 (3–9) days. There were no cases of mitral valve insufficiency greater more than mild degree after mitral valve repair at the time of discharge.

Conclusions. Minimally invasive mitral valve surgery can be performed as a routine standard approach, provides safe and effective correction of the mitral valve defects, allows excellent results of mitral valve repair and replacement in various abnormalities. Minimally invasive approach enables to perform a large number of reconstructive valve techniques and perform simultaneous correction of atrial septal defects, tricuspid valve repair and atrial neoplasm removal.

References

  1. Gammie JS, Sheng S, Griffith BP, Peterson ED, Rankin JS, O’Brien SM, et al. Trends in Mitral Valve Surgery in the United States: Results From The Society of Thoracic Surgeons Adult Cardiac Surgery Database. The Annals of Thoracic Surgery. 2009 May;87(5):1431–9. http://dx.doi.org/10.1016/j.athoracsur.2009.01.064
  2. Schmitto JD, Mokashi SA, Cohn LH. Minimally-Invasive Valve Surgery. Journal of the American College of Cardiology. 2010 Aug;56(6):455–62. https://doi.org/10.1016/j.jacc.2010.03.053.
  3. Rosengart TK, Feldman T, Borger MA, Vassiliades TA, Gillinov AM, Hoercher KJ, et al. Percutaneous and Minimally Invasive Valve Procedures: a scientific statement from the American Heart Association Council on Cardiovascular Surgery and Anesthesia, Council on Clinical Cardiology, Functional Genomics and Translational Biology Interdisciplinary Working Group, and Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation. 2008 Apr;117(13):1750–67. http://dx.doi.org/10.1161/circulationaha.107.188525
  4. Modi P, Hassan A, Chitwood WR. Minimally invasive mitral valve surgery: a systematic review and meta-analysis. European Journal of Cardio-Thoracic Surgery. 2008 Nov;34(5):943–52. http://dx.doi.org/10.1016/j.ejcts.2008.07.057
  5. Falk V, Cheng DCH, Martin J, Diegeler A, Folliguet TA, Nifong LW, et al. Minimally Invasive versus Open Mitral Valve Surgery: a Consensus Statement of the International Society of Minimally Invasive Coronary Surgery (ISMICS) 2010. Innovations (Phila). 2011 Mar;6(2):66–76. https://doi.org/10.1097/IMI.0b013e318216be5c
  6. Cheng DCH, Martin J, Lal A, Diegeler A, Folliguet TA, Nifong LW, et al. Minimally Invasive versus Conventional Open Mitral Valve Surgery: a Meta-Analysis and Systematic Review. Innovations (Phila). 2011 Mar;6(2):84–103. https://doi.org/10.1097/IMI.0b013e3182167feb
  7. Cao C, Gupta S, Chandrakumar D, Indraratna P, Yan TD. A meta-analysis of robotic versus conventional mitral valve surgery. Heart, Lung and Circulation. 2015;24:e68. http://dx.doi.org/10.1016/j.hlc.2014.12.146
  8. Ding C, Jiang D, Tao K, Duan Q, Li J, Kong M, et al. Anterolateral minithoracotomy versus median sternotomy for mitral valve disease: a meta-analysis. Journal of Zhejiang University - SCIENCE B. 2014 Jun;15(6):522–32. http://dx.doi.org/10.1631/jzus.b1300210
  9. McClure RS, Athanasopoulos LV, McGurk S, Davidson MJ, Couper GS, Cohn LH. One thousand minimally invasive mitral valve operations: Early outcomes, late outcomes, and echocardiographic follow-up. The Journal of Thoracic and Cardiovascular Surgery. 2013 May;145(5):1199–206. http://dx.doi.org/10.1016/j.jtcvs.2012.12.070
  10. Davierwala PM, Seeburger J, Pfannmueller B, Garbade J, Misfeld M, Borger MA, et al. Minimally invasive mitral valve surgery: “The Leipzig experience”. Ann Cardiothorac Surg. 2013;2:744–50. http://dx.doi.org/10.3978/j.issn.2225-319X.2013.10.14
  11. Vollroth M, Seeburger J, Garbade J, Borger MA, Misfeld M, Mohr FW. Conversion rate and contraindications for minimally invasive mitral valve surgery. Ann Cardiothorac Surg. 2013;2(6):853–4. https://doi.org/10.3978/j.issn.2225-319X.2013.10.15
  12. Glauber M, Miceli A, Canarutto D, Lio A, Murzi M, Gilmanov D, et al. Early and long-term outcomes of minimally invasive mitral valve surgery through right minithoracotomy: a 10-year experience in 1604 patients. Journal of Cardiothoracic Surgery. 2015 Dec;10(1):181. http://dx.doi.org/10.1186/s13019-015-0390-y
Published
2020-03-24
How to Cite
Babliak, O. D., Demianenko, V. M., Babliak, D. Y., Marchenko, A. I., Revenko, K. A., & Pidgaina, L. V. (2020). Right Minithoraсotomy as a Standard Approach for Mitral Valve Surgery. Ukrainian Journal of Cardiovascular Surgery, (1 (38), 23-28. https://doi.org/10.30702/ujcvs/20.3803/013023-028