Minimally Invasive Approach for Redo Mitral Valve Replacement: No Aortic Cross-Clamping and No Cardioplegia

Kim, Hong Rae; Kim, Gwan Sic; Yoo, Jae Suk; Lee, Jae Won

doi:10.5090/kjtcs.2015.48.2.126

Cited by 5 publications

(4 citation statements)

References 5 publications

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“…[ 11 ] A recent study demonstrated that for patients who needed a second surgery for mitral valve replacement with a history of mitral valvuloplasty through a conventional incision or coronary artery bypass grafting, MI surgery through a right side of the chest incision was a good choice. [ 12 ] One patient received mitral valvuloplasty in our hospital 10 years ago and was admitted to the hospital again because of severe mitral valve stenosis; this patient recovered after MIMVR. Unlike in a traditional surgery with a large drainage volume and slow recovery, the endotracheal tube was removed on the first day after the operation, with a total drainage volume of 560 mL before the tube was removed.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive mitral valve replacement is a safe and effective surgery for patients with rheumatic valve disease

Zhai

Lai²,

Huang³

et al. 2017

Medicine

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The aim of the study was to evaluate the treatment of minimally invasive mitral valve replacement (MIMVR) through a right minithoracotomy for patients with rheumatic mitral valve disease.From February 2009 to December 2016, 360 patients with rheumatic mitral valve disease underwent mitral valve replacement by the same surgeon. Among them, 150 patients accepted MIMVR through a right minithoracotomy, whereas the other 210 accepted a traditional median sternotomy. After matching by patients by age, sex, EuroSCORE, New York Heart Association (NYHA) classification, renal and liver function, and degree of mitral valve disease, we selected 224 patients for analysis in our retrospective study.In the MIMVR group (112 patients), the aortic cross-clamp time (ACC time) (55.25 ± 2.18 minutes) was significantly longer than that in the control group (112 patients; 36.05 ± 1.40 minutes) (P < .0001). In contrast, the cardiopulmonary bypass time (CPB time) was shorter in the MIMVR group than in the control group (61.13 ± 2.57 vs 78.65 ± 4.05 minutes, respectively, P < .0001). Patients who accepted MIMVR surgery had less drainage 24 hours postoperation (324.10 ± 34.55 vs 492.90 ± 34.05 mL, P < .0001) and had less total drainage (713.46 ± 65.35 vs 990.49 ± 67.88 mL, P < .0001) than those who underwent median sternotomy. Thirty-two percent of patients in the MIMVR group needed a blood transfusion (1.35 ± .28 units of red blood cells, 155.36 ± 33.43 mL plasma), whereas 67.0% of the control group needed a blood transfusion (2.15 ± .24 units of red blood cells, 287.50 ± 33.54 mL plasma) (Ptransfusion < .001, Pcell = .029, Pplasma = .006). In total, 5 deaths occurred during the perioperative period; 3 occurred in the MIMVR group. The average hospital stay was significantly shorter in the MIMVR group than that in the control group (6.56 ± .23 vs 8.53 ± .59 days, P = .003).MIMVR, an effective and safe treatment approach for patients suffering from rheumatic mitral valve disease, is associated with less trauma and a faster recovery. It is a better choice for treating simple rheumatic mitral valve disease.

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Section: Discussionmentioning

confidence: 99%

Minimally invasive mitral valve replacement is a safe and effective surgery for patients with rheumatic valve disease

Zhai

Lai²,

Huang³

et al. 2017

Medicine

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show abstract

“…Against the situation mentioned above, minimally invasive beating heart technique for redo mitral valve surgery in patients with giant left ventricle has emerged in this environment. More and more reports had confirmed that minimally invasive beating heart technique for redo cardic surgery could be safely performed successfully [3][4][5][6][7].…”

Section: Discussionmentioning

confidence: 99%

“…Resternotomy may also be complicated in patients who had chest radiotherapy or previous sternal wound infections or in patients with vascular structures (ascending aorta, brachiocephalic vein,right ventricle and bypass vessels) that lie directly behind the sternum. Recently minimally invasive beating heart technique for redo cardic surgery had been safely performed successfully [1][2][3][4][5][6][7], which combined the availability and the advantage of a right-sided minithoracotomy approach without resternotomy and beating heart technique without aortic cross-clamping and cardiac arrest. The beating heart technique can interfere with the mechanisms of ischemia-reperfusion injury [8,9] that may be advantageous particularly in patients with poor left ventricular functions [10][11][12][13][14].…”

mentioning

confidence: 99%

Minimally invasive beating heart technique for redo mitral valve surgery in patients with giant left ventricle

zhang

Wen

et al. 2020

Preprint

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KEYWORDSMinimally invasive, Beating heart technique, Redo mitral valve surgery, Giant left ventricle 2 Abstract Purpose: To analyze the feasibility and efficacy of minimally invasive beating heart technique for redo mitral valve surgery in the cardiac patients with giant left ventricle. Methods: Eighty cardiac patients with giant left ventricle according to the diagnostic criteria that left ventricular end diastolic diameter (LVEDD) was ≥70 mm,who underwent redo mitral valve surgery at our center from January 2006 to January 2019 were analyzed. We divided all patients into minimally invasive beating heart technique group (n=30) and conventional median thoracotomy arrested heart technique group (n=50) according to the surgical methods. Preoperative, intraoperative, and postoperative variables were compared between two groups. Results: Minimally invasive beating heart technique compared to the conventional median thoracotomy arrested heart technique for redo mitral valve surgery in the cardiac patients with giantleft ventricle had significant differences in operation time(P=0.002), cardiopulmonary bypass (CPB) time(P<0.001), intraoperative blood loss(P<0.001), postoperative transfusion ratio(P=0.01), postoperative transfusion amount(P<0.001), postoperative drainage volume(P=0.001), extubation time(P=0.04), intensive care unit (ICU) stay time(P=0.04) and postoperative hospital stay time(P<0.001), but no significant differences in re-exploration for bleeding, postoperative 30-day mortality, postoperative complications, and six months postoperative echocardiographic parameters. Conclusions: Using the method of minimally invasive beating heart technique for redo mitral valve surgery in the cardiac patients with giant left ventricle is feasible, effective, reliable and cosmetic, meanwhile reduce the operation time and CPB time, decrease the transfusion ratio and transfusion amount, shorten postoperative ICU stay and hospital stay time, promote the early extubation so that accelerate the patients' early recovery. BackgroundWith the increasing number of cardiac surgery, more and more cases of mitral valve reoperations are made because of various reasons, such as perivalvular leakage, prosthesis dysfunction, rheumatic valve disease, infective endocarditis, perivalvular tissue hyperplasia, bioprosthetic valve decay. These patients tend to have a long course of disease, this could eventually lead to left ventricular Zhengzhou,450052,

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“…Resternotomy may also be complicated in patients who had chest radiotherapy or previous sternal wound infections or in patients with vascular structures (ascending aorta, brachiocephalic vein, right ventricle and bypass vessels) that lie directly behind the sternum. Recently minimally invasive beating heart technique for redo cardic surgery had been safely performed successfully [1][2][3][4][5][6][7], which combined the availability and the advantage of a right-sided minithoracotomy approach without resternotomy and beating heart technique without aortic cross-clamping and cardiac arrest. The beating heart technique can interfere with the mechanisms of ischemia-reperfusion injury [8,9] that may be advantageous particularly in patients with poor left ventricular functions [10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Minimally invasive beating heart technique for mitral valve surgery in patients with previous sternotomy and giant left ventricle

Zhang

Wen

et al. 2020

J Cardiothorac Surg

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Purpose: To analyze the efficacy of minimally invasive beating heart technique for mitral valve surgery in the cardiac patients with previous sternotomy and giant left ventricle. Methods: Eighty cardiac patients with previous sternotomy and giant left ventricle according to the diagnostic criteria that left ventricular end diastolic diameter (LVEDD) was ≥70 mm, who underwent mitral valve surgery at our center from January 2006 to January 2019 were analyzed. We divided all patients into minimally invasive beating heart technique group (n = 30) and conventional median resternotomy arrested heart technique group (n = 50) according to the surgical methods. Preoperative, intraoperative, and postoperative variables were compared between two groups. Results: Minimally invasive beating heart technique compared to the conventional median resternotomy arrested heart technique for mitral valve surgery in the cardiac patients with previous sternotomy and giant left ventricle had significant differences in operation time(P = 0.002), cardiopulmonary bypass (CPB) time(P < 0.001), intraoperative blood loss(P < 0.001), postoperative transfusion ratio(P = 0.01), postoperative transfusion amount(P < 0.001), postoperative drainage volume(P = 0.001), extubation time(P = 0.04), intensive care unit (ICU) stay time(P = 0.04) and postoperative hospital stay time(P < 0.001), but no significant differences in re-exploration for bleeding, postoperative 30-day mortality, postoperative complications and 6 months postoperative echocardiographic parameters. Conclusions: Using the method of minimally invasive beating heart technique for mitral valve surgery in the cardiac patients with previous sternotomy and giant left ventricle is effective and reliable, meanwhile reduce the operation time and CPB time, decrease the transfusion ratio and transfusion amount, shorten postoperative ICU stay and hospital stay time, promote the early extubation so that accelerate the patients' early recovery. All of these show a benefit of minimally invasive beating heart technique compared to conventional median resternotomy arrested heart technique.

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Minimally Invasive Approach for Redo Mitral Valve Replacement: No Aortic Cross-Clamping and No Cardioplegia

Cited by 5 publications

References 5 publications

Minimally invasive mitral valve replacement is a safe and effective surgery for patients with rheumatic valve disease

Minimally invasive mitral valve replacement is a safe and effective surgery for patients with rheumatic valve disease

Minimally invasive beating heart technique for redo mitral valve surgery in patients with giant left ventricle

Minimally invasive beating heart technique for mitral valve surgery in patients with previous sternotomy and giant left ventricle

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