Development of a minimally invasive mitral valve surgery program – The Innsbruck experience

Ruttmann, Elfriede; Laufer, Günther; Müller, Ludwig

doi:10.1007/s10353-006-0276-2

Cited by 6 publications

(6 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…All-cause mortality did not differ between minimally invasive and conventional open MVR (1.2% vs 1.5%; RR 1.03, 95% CI 0.75-1.42; 20 studies). 5,6,8,12,13,[15][16][17][18][19]21,26,28,31,32,[34][35][36][37][38] Two RCTs involving 140 patients reported no mortality in minimally invasive and conventional open MVR. 12,13 Subanalysis by endoaortic or transthoracic clamping also showed no significant difference for all-cause mortality between minimally invasive and conventional open MVR.…”

Section: All-cause Mortalitymentioning

confidence: 99%

“…Reoperation for bleeding was not significantly different between mini-MVS and conv-MVS groups (3.5% vs 2.9%, RR 0.91 95% CI 0.59-1.41; 14 studies). 6,8,12,14,15,21,26,28,32,[34][35][36][37][38] There was no significant heterogeneity among the studies ( Fig. 5; Table 3).…”

Section: Reoperation For Bleedingmentioning

confidence: 99%

“…The proportion of patients with mitral insufficiency postoperatively was not significantly different between mini-MVS and conv-MVS groups (2.4% vs 2%, RR 1.16, 95% CI 0.38 -3.57; five studies). 12,15,21,28,38 One of the studies was an RCT, and it showed no significant difference between groups for mitral regurgitation. 12 There was no significant heterogeneity among the studies (Table 4).…”

Section: Mitral Insufficiencymentioning

confidence: 99%

“…Length of stay in ICU was significantly reduced for mini-MVS versus conv-MVS (1.6 vs 2.4 days, WMD Ϫ0.50 days, 95% CI Ϫ0.68 to Ϫ0.32 days; 18 studies). 5,7,8,11,12,14,15,17,21,24,[27][28][29]31,33,[35][36][37] There was significant heterogeneity for this outcome. The one RCT that reported this outcome showed no significant difference in the length of stay in ICU between mini-and conv-MVS (WMD Ϫ0.30 hours, 95% CI Ϫ92 to ϩ0.32 hours) ( Table 7).…”

Section: Length Of Stay In Icumentioning

confidence: 99%

See 3 more Smart Citations

Minimally Invasive versus Conventional Open Mitral Valve Surgery a Meta-Analysis and Systematic Review

Cheng

Martin

Lal

et al. 2011

Innovations�(Phila)

258

View full text Add to dashboard Cite

Objective This meta-analysis sought to determine whether minimally invasive mitral valve surgery (mini-MVS) improves clinical outcomes and resource utilization compared with conventional open mitral valve surgery (conv-MVS) in patients undergoing mitral valve repair or replacement. Methods A comprehensive search of MEDLINE, Cochrane Library, EMBASE, CTSnet, and databases of abstracts was undertaken to identify all randomized and nonrandomized studies up to March 2010 of mini-MVS through thoracotomy versus conv-MVS through median sternotomy for mitral valve repair or replacement. Outcomes of interest included death, stroke, myocardial infarction, aortic dissection, need for reintervention, and any other reported clinically relevant outcomes or indicator of resource utilization. Relative risk and weighted mean differences and their 95% confidence intervals were analyzed as appropriate using the random effects model. Heterogeneity was measured using the I2 statistic. Results Thirty-five studies met the inclusion criteria (two randomized controlled trials and 33 nonrandomized studies). The mortality rate after mini-MVS versus conv-MVS was similar at 30 days (1.2% vs 1.5%), 1 year (0.9% vs 1.3%), 3 years (0.5% vs 0.5%), and 9 years (0% vs 3.7%). A number of clinical outcomes were significantly improved with mini-MVS versus conv-MVS including atrial fibrillation (18% vs 22%), chest tube drainage (578 vs 871 mL), transfusions, sternal infection (0.04% vs 0.27%), time to return to normal activity, and patient scar satisfaction. However, the 30-day risk of stroke (2.1% vs 1.2%), aortic dissection/injury (0.2% vs 0%), groin infection (2% vs 0%), and phrenic nerve palsy (3% vs 0%) were significantly increased for mini-MVS versus conv-MVS. Other clinical outcomes were similar between groups. Cross-clamp time, cardiopulmonary bypass time, and procedure time were significantly increased with mini-MVS; however, ventilation time and length of stay in intensive care unit and hospital were reduced. Conclusions Current evidence suggests that mini-MVS maybe associated with decreased bleeding, blood product transfusion, atrial fibrillation, sternal wound infection, scar dissatisfaction, ventilation time, intensive care unit stay, hospital length of stay, and reduced time to return to normal activity, without detected adverse impact on long-term need for valvular reintervention and survival beyond 1 year. However, these potential benefits for mini-MVS may come with an increased risk of stroke, aortic dissection or aortic injury, phrenic nerve palsy, groin infections/complications, and increased cross-clamp, cardiopulmonary bypass, and procedure time. Available evidence is largely limited to retrospective comparisons of small cohorts comparing mini-MVS versus conv-MVS that provide only short-term outcomes. Given these limitations, randomized controlled trials with adequate power and duration of follow-up to measure clinically relevant outcomes are recommended to determine the balance of benefits and risks.

show abstract

Section: All-cause Mortalitymentioning

confidence: 99%

Section: Reoperation For Bleedingmentioning

confidence: 99%

Section: Mitral Insufficiencymentioning

confidence: 99%

Section: Length Of Stay In Icumentioning

confidence: 99%

See 2 more Smart Citations

Minimally Invasive versus Conventional Open Mitral Valve Surgery a Meta-Analysis and Systematic Review

Cheng

Martin

Lal

et al. 2011

Innovations�(Phila)

258

View full text Add to dashboard Cite

show abstract

“…Although the minimally invasive access has become a valid alternative to conventional surgery by full median sternotomy in recent years [1], it remains unclear if the benefits which comprehend mainly cosmesis, blood loss, ICU time, hospital stay and return to work also are true for the elderly population. These patients usually suffer from more comorbidities and the advantages of the MICS approach may well be offset by an increase of complications and mortality.…”

Section: Introductionmentioning

confidence: 98%

Minimally invasive mitral valve surgery in the old patient

et al. 2011

Self Cite

View full text Add to dashboard Cite

Zusammenfassung. Grundlagen: Die minimal invasive Operation der Mitralklappe ist heute eine bewährte Alternative zur konventionellen Operation durch mediane Sternotomie. Trotzdem bleibt unklar, inwieweit die objektiven Vorteile von Kosmetik, Blutverlust, Intensivstations-und Krankenhausaufenthalt sowie Wiederaufnahme der Arbeit auch bei älteren Patienten zum Tragen kommen oder vielleicht durch zusätzliche Komplikationen mit erhöhter Morbidität und Mortalität aufgewogen werden. Darü ber hinaus bleibt die Frage ungeklärt, ob diejenigen Erkrankungen, welche bei älte-ren Menschen vorwiegend gefunden werden, mit der minimal invasiven Methode ü berhaupt angegangen werden können. Methodik: Patienten über 75 Jahre, die in unserer Anteilung von 2001-2009 eine minimal invasive Mitralklappenoperation erhalten hatten, wurden hinsichtlich Operationsart (isolierte Mitralklappenoperation oder Kombination mit Trikuspidalklappenoperation oder Vorhofsablation bei Vorhofflimmern), perioperative Mortalität und intraoperativen Komplikationen untersucht. Die Ergebnisse werden der neueren Literatur gegenübergestellt. Ergebnisse: Von 2001 bis 2009 wurden von insgesamt 253 minimal invasiven Mitralklappenoperationen 30 % bei Patienten über 70, 14 % über 75 und 4 % über 80 Jahre durchgeführt. Die Mortalität betrug 1,3 % bei den älteren Patienten, gegenüber 0,8 % in der Gesamtpopulation. Der Anteil von Klappenersatzoperationen war bei den älteren Patienten gleich wie bei den jüngeren (11 % vs. 12,4 %).Schlussfolgerungen: Anders als der Aortenklappenersatz werden minimal invasive Mitralklappenoperationen nur in einem relativ kleinen Prozentsatz bei älteren Patienten durchgefü hrt. Auf Grund unserer Ergebnisse können minimal invasive Operationen jedoch auch bei älteren Patienten mit ausgezeichneten Ergebissen durchgefü hrt werden. Daten aus der rezenten Literatur bestäti-gen diesen Schluss. Eine Verminderung des chirurgischen Traumas fü hrt auch bei älteren Patienten nicht nur zu verbesserten kosmetischen Ergebnissen, sondern ist auch sicher.Schlüsselwörter: Minimal invasive Mitralklappenoperation, ältere Patienten.Summary. Background: Minimally invasive (MICS) mitral valve surgery has become a valid alternative to the conventional approach by full median sternotomy; nevertheless, it remains unclear if the benefits, which comprehend mainly cosmesis, blood loss, ICU time, hospital stay and return to work also are true for the elderly population and may not be offset by additional complications resulting in an increased morbidity and mortality. Moreover the question remains if the diseases prevailing in the elderly population can be approached by the minimally invasive technique.Methods: Patients 75 years or older treated in our institution from 2001 to 2009 by MICS mitral valve surgery are analyzed in respect to type of surgery (isolated mitral valve surgery or combined with tricuspid or atrial fibrillation surgery), perioperative mortality and intraoperative complications. The results are related to recent literature.Results: Out of 253 MICS ...

show abstract

Open vs. Minimally Invasive Mitral Valve Surgery: Surgical Technique, Indications and Results

Sündermann

Czerny

Falk

2015

Cardiovasc Eng Tech

View full text Add to dashboard Cite

Minimally invasive procedures are the standard approach in many centres but are still under debate in regards of inferiority compared to conventional mitral valve surgery through a median sternotomy. The aim of this review was to summarize the current literature comparing minimally invasive mitral valve surgery (MIVS) and conventional mitral valve surgery. In this review of the current literature, we summarize our findings from a recent meta-analysis and add information from papers that were published afterwards. There were no differences between patients treated minimally invasive or through a conventional sternotomy approach in regards of perioperative stroke rate and mortality. Procedural time, cardio-pulmonary-bypass time and cross-clamp time were longer in the MIVS group. In contrast, length of intensive care unit (ICU) stay and length of in hospital stay were significantly reduced in this group. Need for blood transfusion was lower in the MIVS group. Other outcomes like i.e., the rate of rethoracotomies or renal failure didn't differ between the groups. Repair rates and long-term freedom from recurrence of mitral regurgitation and reoperation are similar. Newer publications underline these findings. The current literature shows that MIVS and conventional mitral valve surgery show a similar perioperative outcome. Minimally invasive mitral valve surgery is favourable with regards to ICU stay, in hospital stay as well as need for blood transfusion.

show abstract

Development of a minimally invasive mitral valve surgery program – The Innsbruck experience

Cited by 6 publications

References 25 publications

Minimally Invasive versus Conventional Open Mitral Valve Surgery a Meta-Analysis and Systematic Review

Minimally Invasive versus Conventional Open Mitral Valve Surgery a Meta-Analysis and Systematic Review

Minimally invasive mitral valve surgery in the old patient

Open vs. Minimally Invasive Mitral Valve Surgery: Surgical Technique, Indications and Results

Contact Info

Product

Resources

About