Cardiac Surgery in Germany during 2010: A Report on Behalf of the German Society for Thoracic and Cardiovascular Surgery

Gummert, Jan; Funkat, Anne-Kathrin; Beckmann, Andreas; Ernst, Moritz; Hekmat, Khosro; Beyersdorf, Friedhelm; Schiller, Wolfgang

doi:10.1055/s-0030-1271191

Cited by 67 publications

(43 citation statements)

References 26 publications

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“…14 Increased acceptance of MIS-MV is probably attributable to a combination of the following factors: improved instruments for surgical access with good visualization of the mitral valve, preservation of the integrity of the osseous thoracic wall, faster patient recovery, very good short-and long-term results with high rates of mitral valve repair, and increasing patient demand. 15 Patient demand is likely to increase as knowledge of percutaneous mitral valve repair methods becomes increasingly widespread, which may lead to more surgeons adopting the MIS-MV technique.…”

Section: Discussionmentioning

confidence: 99%

Learning Minimally Invasive Mitral Valve Surgery

et al. 2013

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Background-Learning curves are vigorously discussed and viewed as a negative aspect of adopting new procedures.However, very few publications have methodically examined learning curves in cardiac surgery, which could lead to a better understanding and a more meaningful discussion of their consequences. The purpose of this study was to assess the learning process involved in the performance of minimally invasive surgery of the mitral valve using data from a large, single-center experience. Methods and Results-All mitral (including tricuspid, or atrial fibrillation ablation) operations performed over a 17-year period through a right lateral mini-thoracotomy with peripheral cannulation for cardiopulmonary bypass (n=3907) were analyzed. Data were obtained from a prospective database. Individual learning curves for operation time and complication rates (using sequential probability cumulative sum failure analysis) and average results were calculated. A total of 3895 operations by 17 surgeons performing their first minimally invasive surgery of the mitral valve operation at our institution could be evaluated. The typical number of operations to overcome the learning curve was between 75 and 125. Furthermore, >1 such operation per week was necessary to maintain good results. Individual learning curves varied markedly, proving the need for good monitoring or mentoring in the initial phase. Data were drawn from a prospectively gathered database for MIS-MV housed at our institution. The study was approved for anonymous analysis by the institutional review board, with additional patient consent waived. Conclusions Patient Selection and Surgical TechniqueIt is the policy at our institution to use the MIS-MV approach whenever possible. The main reasons for not using minimally invasive procedures were previous right thoracotomy with expected lung adhesions, difficulties with femoral vessel cannulation, and in the case or urgent or emergent surgery, the unavailability of a surgeon versed in the MIS-MV approach. Other possible reasons for preferring the sternotomy approach were a very low ejection fraction (to achieve the shortest possible cross-clamp time) and expected difficulties with valve replacement because of extremely severe annular calcification or deep annular abscess. Such decisions were made at the surgeon's discretion.In all patients who underwent an MIS-MV, a right-lateral minithoracotomy and femoral cannulation for cardiopulmonary bypass with mild to moderate hypothermia were performed. In the vast majority of patients, a transthoracic aortic clamp as introduced by Chitwood et al 8 was used. Details on the MIS-MV operative approach are described more thoroughly elsewhere. 2,9 Patients who underwent robotic mitral valve surgery were excluded. Data AnalysisCategorical variables are expressed as proportions and continuous variables as mean±SD throughout this study. Patients were divided into groups of 50 consecutive operations to evaluate the influence of growing surgical experience on adverse outcomes. Testing for ...

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Section: Discussionmentioning

confidence: 99%

Learning Minimally Invasive Mitral Valve Surgery

et al. 2013

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“…In the majority of the population, intervention has low risk and is able to promote functional improvement and increase the survival rate when compared to clinical treatment [2.13]. Nevertheless, a progressively larger portion of that population has necessitated the replacement of dysfunctional prosthesis and, consequently, higher operative risk [14].…”

Section: Discussionmentioning

confidence: 99%

Transcatheter aortic valve-in-valve implantation: a selection change?

Gaia¹,

Couto²,

Breda³

et al. 2012

Revista Brasileira De Cirurgia Cardiovascular

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Objective: Aortic valve replacement for bioprosthesis dysfunction is a procedure involving considerable risk. In some cases, mortality is high and may contraindicate the procedure. Minimally invasive transcatheter aortic "valvein-valve" implant appears to be an alternative, reducing morbidity and mortality. The objective is to evaluate aortic valve-in-valve procedure using Braile Inovare prosthesis.Methods: The Braile Inovare prosthesis, transcatheter, expandable balloon, was used in 14 cases. Average EuroSCORE was 42.9%. All patients had double aortic bioprosthesis dysfunction. Procedures were performed in a surgical hybrid environment under echocardiographic and fluoroscopic guidance. Using left minithoracotomy prostheses were implanted through the ventricular apex under high-frequency ventricular pacing. Serial clinical and echocardiographic controls were performed. Follow-up ranged 1-30 months.Results: Correct prosthetic deployment was obtained in all cases. There was no conversion. There was no operative mortality. The 30-day mortality was 14.3% (two cases). Ejection fraction increased significantly after the 7 th postoperative day. Aortic gradient significantly reduced. The residual aortic regurgitation was not present. There were no vascular complications or complete atrioventricular block. Conclusion:The transcatheter "valve-in-valve" procedure for bioprosthesis dysfunction is safe with low morbidity. This possibility may change prosthesis choice during the first aortic valve replacement, favoring bioprostheses. Descriptors

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“…Over the last 5 years, the number of patients undergoing the procedure has increased as some patients and clinicians have realised there are potential benefits of minimally invasive surgery (25,(88)(89)(90)(91). This expansion in minimally invasive mitral valve surgery has occurred particularly in Europe and the United States (90, 91), but has been more limited within the UK NHS.…”

Section: Choice Of Comparatorsmentioning

confidence: 99%