Feasibility, safety, and short-term outcome of totally thoracoscopic mitral valve procedure

Abstract

BackgroundThe totally thoracoscopic procedure for mitral valve (MV) disease is a minimally invasive method. We investigated the procedure’s feasibility, safety and effectiveness when it was performed by an experienced operator.MethodsWe retrospectively analysed 53 consecutive patients with MV disease treated between December 2014 and April 2017 by minimally invasive procedures. The procedures were performed on femoral artery-vein bypass through three 2–4 cm incisions, with one additional penetrating point on the right chest wall under totally thoracoscopic visual guidance and surveillance of transoesophageal echocardiography.ResultsTwo patients who underwent intraoperative conversion to sternotomy were excluded due to indivisible pleural cavity adhesion. Of the others (38 female patients, average age, 49 ± 14 years, left ventricular ejection fraction, 59 ± 7%), 34 received MV replacement for rheumatic mitral lesions, which was redone for one patient after the discovery of serious paravalvular leakage, 17 received MV repair for mitral regurgitation (with 4 secondary to atrial septum defect, 2 diagnosed with left atrial myxoma, and 2 redone for mitral valve replacement due to repair failure), 28 received additional tricuspid valvuloplasty, and one patient received a Warden procedure. The cardiopulmonary bypass and aortic cross clamp times were 144 ± 39 min and 80 ± 22 min, respectively. Postoperational chest tube drainage in the first 48 h was 346 ± 316 ml. The ventilation time and intensive care unit stay length were 11 ± 11 h and 23 ± 2 h, respectively. One patient died of disseminated intravascular coagulation and prosthesis thrombosis with fear of anticoagulation-related bleeding.ConclusionsThe totally thoracoscopic procedure on mitral valves by an experienced surgeon is technically feasible, safe, effective and worthy of widespread adoption in clinical practice.

Early outcomes of mitral valvuloplasty by minimally invasive surgery or sternotomy

“…9 During mitral valvuloplasty via a totally thoracoscopic minimally invasive approach, the morphological structure and lesion site of the mitral valve can be clearly displayed on the thoracoscopic display screen to facilitate carrying out precise operations, and atrial fibrillation radiofrequency ablation and tricuspid valve surgery can be concurrently performed. 1 Compared to mitral valvuloplasty via the traditional median sternotomy, totally thoracoscopic mitral valvuloplasty benefits patients as follows: mild wound pain and mild discomfort/symptoms after surgery; more coordination for the implementation of subsequent rehabilitation work; support of early off-bed activities; better spontaneous cough and expectoration; good functional recovery of the heart, lungs, and gastrointestinal tract; more rapid recovery after surgery; a shorter hospital stay; reduced hospitalization costs; and a satisfactory overall effect. 10 In China, mitral valvuloplasty under direct vision via a median sternotomy has become routine, but totally thoracoscopic mitral valvuloplasty is still at an early stage of development and is performed in only a few medical institutions.…”

“…Compared to mitral valvuloplasty via the traditional median sternotomy, mitral valvuloplasty via a totally thoracoscopic minimally invasive approach maintains the integrity of the osseous structure of the thoracic wall, requires a small cosmetically superior incision, and allows a more rapid postoperative recovery; thus, this procedure is preferred by an increasing number of patients. 1 For example, in Leipzig Medical Center, Germany, since the introduction of minimally invasive mitral valve surgery in 1994, an annual surgical volume of nearly 400 cases has been maintained, which accounts for more than 80% of the total mitral valve surgery volume. 2 In China, thoracoscopic cardiac surgery was first performed in Xijing Hospital of the Fourth Military Medical University at the beginning of the 21st century, and in the last 18 years, it has developed rapidly in the cardiac surgery departments of various large-sized hospitals; over 10,000 cases of various cardiac surgeries have been completed under thoracoscopy in more than 40 Chinese hospitals, with good clinical results.…”

The impact of medical insurance reimbursement on postoperative inflammation reaction in distinct cardiac surgery from a single center

“…The clinical data were collected from historical medical records, such as the durations of cardiopulmonary bypass (CPB), aortic cross-clamping (ACC) and the procedure administration, mechanical ventilation time, thoracic drainage volume, and the length of ICU and hospital stay [ 9 ].…”

Comparison between Different Tricuspid Valve Procedures through Postoperative Inflammation and Myocardial Enzymes

“…Several kinds of minimally invasive access for TV procedures in adult patients have been popularly introduced into clinical practice. TVS through lower hemisternotomy and right lateral minithoracotomy were safe approaches with very low operative mortality compared to standard median sternotomy [ 1 , 2 ] .…”