Comparison of outcomes of minimally invasive mitral valve surgery for posterior, anterior and bileaflet prolapse☆

Seeburger, Joerg; Borger, Michael A.; Doll, Nicolas; Walther, Thomas; Passage, Jürgen; Falk, Volkmar; Mohr, Friedrich W.

doi:10.1016/j.ejcts.2009.03.058

Cited by 113 publications

(80 citation statements)

References 15 publications

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“…The percentage of patients who required mitral valve reoperation during follow-up has been described in detail in previous publications from our institution, with reoperation rates that are within the range of results published for full sternotomy mitral valve surgery. 2,3,13 However, these studies come from high-volume centers with vast experience in MIS-MV surgery.…”

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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“…Referring cardiologists and patients alike are seeking centers of excellence capable of performing mitral valve, tricuspid valve, atrial septal defect, and intracardiac tumor surgical procedures with nonsternotomy techniques. Several reports from our center and from others have demonstrated excellent technical outcomes that are equivalent to the gold standard sternotomy approaches [1][2][3][4][5][6][7][8][9][10][11]. The most commonly described minimally invasive approach to the left and right atria for mitral valve, tricuspid valve, atrial septal defect, and intracardiac tumor operations is through a limited right thoracotomy with the use of either endoscopic port access or robotic techniques.…”

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confidence: 90%

Port Access Cardiac Operations Can Be Safely Performed With Either Endoaortic Balloon or Chitwood Clamp

Atluri

Goldstone

Fox

et al. 2014

The Annals of Thoracic Surgery

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“…Tab. 1 [9]. Patienten mit verkalkten Mitralklappen haben dahingegen eine deutlich eingeschränkte Rekonstruktionswahrscheinlichkeit.…”

Section: Pathophysiologie Der Mitralklappeunclassified

“…3 dargestellt, aufgeschlüsselt nach den Pathologien: Wird ein Prolaps des vorderen Segels oder beider Klappensegel behandelt, kommt es bei der Resect-Strategie zu deutlich mehr Reoperationen [11], als wenn eine reine Pathologie des hinteren Segels vorliegt. Bei der Respect-Strategie unter Verwendung von Gore-Tex ® -Loops ist die Häu-figkeit einer Reoperation dagegen unabhängig von der Segelpathologie [9]. Zudem legt eine kürzlich veröffentlichte Studie nahe, dass die Respect-Strategie mit einer Verbesserung der postoperativen linksventrikulären Funktion assoziiert ist [12].…”

Section: » Bei Der Respect-strategie Ist Die Häufigkeit Einer Reoperaunclassified

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Moderne Mitralklappenchirurgie

Bothe

Beyersdorf

2016

Internist

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At the beginning of the 20th century, Cutler and Levine performed the first successful surgical treatment of a stenotic mitral valve, which was the only treatable heart valve defect at that time. Mitral valve surgery has evolved significantly since then. The introduction of the heart-lung machine in 1954 not only reduced the surgical risk, but also allowed the treatment of different mitral valve pathologies. Nowadays, mitral valve insufficiency has become the most common underlying pathomechanism of mitral valve disease and can be classified into primary and secondary mitral insufficiency. Primary mitral valve insufficiency is mainly caused by alterations of the valve (leaflets and primary order chords) itself, whereas left ventricular dilatation leading to papillary muscle displacement and leaflet tethering via second order chords is the main underlying pathomechanism for secondary mitral valve regurgitation. Valve reconstruction using the "loop technique" plus annuloplasty is the surgical strategy of choice and normalizes life expectancy in patients with primary mitral regurgitation. In patients with secondary mitral regurgitation, implanting an annuloplasty is not superior to valve replacement and results in high rates of valve re-insufficiency (up to 30 % after 3 months) due to ongoing ventricular dilatation. In order to improve repair results in these patients, we add a novel subvalvular technique (ring-noose-string) to the annuloplasty that aims to prevent ongoing ventricular remodeling and re-insufficiency. In modern mitral surgery, a right lateral thoracotomy is the approach of choice with excellent repair and cosmetic results.

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Comparison of outcomes of minimally invasive mitral valve surgery for posterior, anterior and bileaflet prolapse☆

Abstract: Minimally invasive MV repair can be achieved with excellent results. Long-term outcomes and reoperation rates for AML prolapse are not significantly different from PML or BL prolapse.

Cited by 113 publications

References 15 publications

Learning Minimally Invasive Mitral Valve Surgery

Learning Minimally Invasive Mitral Valve Surgery

Port Access Cardiac Operations Can Be Safely Performed With Either Endoaortic Balloon or Chitwood Clamp

Moderne Mitralklappenchirurgie

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