A New Left Atrial Retractor for Minimally Invasive Mitral Valve Surgery

Murzi, Michele; Solinas, Marco; Bevilacqua, Stefano; Gasbarri, Tommaso; Glauber, Mattia; Cerillo, Alfredo Giuseppe

doi:10.1111/j.1540-8191.2008.00719.x

Cited by 5 publications

(2 citation statements)

References 6 publications

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“…Although this study only targeted patients who underwent EMVS, the results of this study are expected to have significance for all types of minimally invasive MV surgeries, including robotic and direct-vision mini-MV surgery. Although the issue of suboptimal MV exposure during EMVS has been raised previously [ 4 , 5 , 12 , 13 ], few studies have proposed its clear definition, incidence and impact on surgery, largely due to the difficulty in objectively defining poor exposure. However, in our study, the surgical field of view could be recorded and analysed retrospectively by multiple reviewers owing to the use of totally endoscopic surgery.…”

Section: Discussionmentioning

confidence: 99%

Prediction of poor exposure in endoscopic mitral valve surgery using computed tomography

Jung,

van Kuijk,

Gietema

et al. 2024

European Journal of Cardio-Thoracic Surgery

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Objectives In endoscopic mitral valve surgery, optimal exposure is crucial. This study aims to develop a predictive model for poor mitral valve exposure in endoscopic surgery, utilizing preoperative body profiles and computed tomography images. Methods We enrolled patients undergoing endoscopic mitral valve surgery with available operative video and preoperative computed tomography. The degree of valve exposure was graded into 0 (excellent), 1 (fair), 2 (poor), and 3 (very poor). Intrathoracic dimensions–anteroposterior width (chest AP) and left-to-right width (chest width) of the thorax, height of right hemi-thorax (chest height), angle between the left ventricular axis and the horizontal plane (LV apex angle), heart width, level of diaphragm in midline, and vertical distance between the midline diaphragm level and the highest top of the right diaphragm (Δdiaphragm) — were measured. Results Among 263 patients, mitral valve exposure was graded as 0 in 131 (49.8%), 1 in 72 (27.4%), 2 in 46 (17.5%), and 3 in 14 (5.3%). Body mass index, chest width, LV apex angle, heart width, and Δdiaphragm were identified as independent predictors of grade 2 and 3 exposure by stepwise logistic regression analysis, with an area under the receiver operating characteristic curve (AUC) of 0.822 (P < 0.001). Univariate logistic regression for grade 3 exposure prediction revealed that Δdiaphragm had the largest AUC (0.826, P < 0.001). Conclusions Poor mitral valve exposure occurred in approximately 1/4 of the endoscopic surgery series and might be predicted preoperatively using body mass index and computed tomography measurements to help determine the surgical approach.

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Section: Discussionmentioning

confidence: 99%

Prediction of poor exposure in endoscopic mitral valve surgery using computed tomography

Jung,

van Kuijk,

Gietema

et al. 2024

European Journal of Cardio-Thoracic Surgery

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“…It gently retracts the atrial walls, creating a conical space, which leaves a free 1-cm rim of atrial muscle all around the mitral annulus, protecting atrial wall by accidental damage but providing little space for suturing. Furthermore, this kind of retraction may increase the risk of injury of aortic cusps and left ventricular outflow tract, because the mitral annulus is pushed toward the interventricular septum (11,12).…”

Section: Trans-working-port Retractorsmentioning

confidence: 99%