Minimally invasive redo mitral valve surgery without aortic crossclamp

Milani, Rodrigo; Brofman, Paulo Roberto Slud; Oliveira, Sérgio Almeida de; Neto, Luiz Patrial; Rosa, Matheus; Lima, Victor Hugo; Binder, Luis Fernando; Sanches, Aline

doi:10.5935/1678-9741.20130051

Cited by 3 publications

(2 citation statements)

References 17 publications

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“…A técnica exige adaptação do cirurgião ao abordar as cavidades cardíacas de forma restrita pelo comprimento limitado da incisão, o que é compensado pelo uso da videotoracoscopia. O manuseio de instrumentos longos e a visibilidade indireta do campo operatório são dificuldades superadas gradativamente pela sucessão de intervenções cirúrgicas, através da qual as habilidades e destrezas nas manipulações são aperfeiçoadas 10 .…”

Section: Discussionunclassified

Atuação da enfermagem em cirurgia cardíaca minimamente invasiva videoassistida*

Sene

Jardim

2016

Rev SOBECC

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Objetivo: Relatar a atuação da enfermagem no perioperatório da cirurgia cardíaca minimamente invasiva videoassistida. Método: Trata-se deum relato de experiência da equipe de enfermagem no perioperatório dessa técnica cirúrgica, realizada em um hospital-escola que é referência em cardiologiano Estado de São Paulo. Resultados: Observa-se a importância da atuação da enfermagem no preparo do centro cirúrgico (CC), recepção dopaciente, assistência ao ato anestésico, preparo do paciente para a cirurgia, atendimento à equipe no período intraoperatório e na saída do paciente desala operatória (SO), atendendo às demandas desta modalidade cirúrgica inovadora. Conclusão: A enfermagem de centro cirúrgico (CC) deve ser capacitadaa acompanhar a evolução das técnicas cirúrgicas, tanto no manuseio dos novos materiais e equipamentos como na assistência direta ao paciente,visando à segurança cirúrgica.

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Section: Discussionunclassified

Atuação da enfermagem em cirurgia cardíaca minimamente invasiva videoassistida*

Sene

Jardim

2016

Rev SOBECC

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“…Thus, in this subset of patients, avoiding dissection of the ascending without aortic crossclamping (WAC) approach could be performed limiting the risk of aortic and pulmonary artery and graft tissue dissection. [2][3][4][5][6] Moreover, in subsets with secondary MR associated with low ejection fraction (EF), WAC approach has been reported to be effective by preserving myocardial contractility. 7 In this retrospective bicentric study, we evaluate the results of MIMVS-WAC in patients with secondary MR associated with low EF or previous heart surgery.…”

Section: Introductionmentioning

confidence: 99%

Minithoracotomy and Beating Heart Strategy for Mitral Surgery in Secondary Mitral Regurgitation

Grinberg

Pozzi

Bordet

et al. 2019

Thorac Cardiovasc Surg

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Background In patients with secondary mitral regurgitation (MR) associated with low ejection fraction or previous heart surgery, minimally invasive mitral valve surgery without aortic cross-clamp (MIMVS-WAC) has shown promising results. We report our experience for this strategy in our centers. Methods Between August 2011 and April 2017, 46 patients (mean age 69 ± 11 years, 76% males) received MIMVS-WAC. Indications for this technique were prior coronary bypass surgery (26%), severe or recent left ventricular (LV) dysfunction (30%), or both (39%). The mean EuroSCORE II was 12 ± 10. Results For each procedure, we conducted right minithoracotomy and hypothermic cardiopulmonary bypass (CPB) after peripheral cannulation. Mean CPB time was 159 ± 39 minutes. A mitral valve replacement (MVR) was performed in 23 cases (50%), an annuloplasty in 22 cases (48%), and a prosthesis pannus removal in 1 case (2%). Mean hospital length of stay was 12 ± 5.4 days. We report no sternotomy conversions, six reoperations for bleeding, and three deaths at 30 days. Transfusion was requested in 62% (mean infusion 2 ± 2.4 packed red blood cells). The postoperative echocardiography showed an LV function preservation in 69% of cases and a reduction of pulmonary arterial pressure in 73% of cases. Four additional deaths occurred in the long-term follow-up (mean 637 ± 381 days, median 593 days). No mitral reoperation was required, with a MR ≤ 2 in 90% of patients. Conclusion In high-risk patients, the MIMVS-WAC is a safe technique. It avoids hard dissections while ensuring excellent preservation of cardiac function.

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