Minimally invasive mitral valve replacement is a safe and effective surgery for patients with rheumatic valve disease

Abstract

The aim of the study was to evaluate the treatment of minimally invasive mitral valve replacement (MIMVR) through a right minithoracotomy for patients with rheumatic mitral valve disease.From February 2009 to December 2016, 360 patients with rheumatic mitral valve disease underwent mitral valve replacement by the same surgeon. Among them, 150 patients accepted MIMVR through a right minithoracotomy, whereas the other 210 accepted a traditional median sternotomy. After matching by patients by age, sex, EuroSCORE, New York Heart Association (NYHA) classification, renal and liver function, and degree of mitral valve disease, we selected 224 patients for analysis in our retrospective study.In the MIMVR group (112 patients), the aortic cross-clamp time (ACC time) (55.25 ± 2.18 minutes) was significantly longer than that in the control group (112 patients; 36.05 ± 1.40 minutes) (P < .0001). In contrast, the cardiopulmonary bypass time (CPB time) was shorter in the MIMVR group than in the control group (61.13 ± 2.57 vs 78.65 ± 4.05 minutes, respectively, P < .0001). Patients who accepted MIMVR surgery had less drainage 24 hours postoperation (324.10 ± 34.55 vs 492.90 ± 34.05 mL, P < .0001) and had less total drainage (713.46 ± 65.35 vs 990.49 ± 67.88 mL, P < .0001) than those who underwent median sternotomy. Thirty-two percent of patients in the MIMVR group needed a blood transfusion (1.35 ± .28 units of red blood cells, 155.36 ± 33.43 mL plasma), whereas 67.0% of the control group needed a blood transfusion (2.15 ± .24 units of red blood cells, 287.50 ± 33.54 mL plasma) (Ptransfusion < .001, Pcell = .029, Pplasma = .006). In total, 5 deaths occurred during the perioperative period; 3 occurred in the MIMVR group. The average hospital stay was significantly shorter in the MIMVR group than that in the control group (6.56 ± .23 vs 8.53 ± .59 days, P = .003).MIMVR, an effective and safe treatment approach for patients suffering from rheumatic mitral valve disease, is associated with less trauma and a faster recovery. It is a better choice for treating simple rheumatic mitral valve disease.

Mitral prosthetic size predictor in minimally invasive mitral valve replacement

“…We experienced one case of mitral annulus rupture while performing valve replacement via the minimally invasive approach, this has been reported elsewhere [9]. Zhai et al also reported two cases of cardiac rupture in a population undergoing minimally invasive mitral surgery, both patients died [10]. On the other hand, PPM was also reported in patients with mitral valve replacement.…”

Mitral Prosthetic Size Predictor in Minimally Invasive Mitral Valve Replacement

“…We experienced one case of mitral annulus rupture while performing valve replacement via the minimally invasive approach, this has been reported elsewhere (9). Zhai et al also reported two cases of cardiac rupture in a population underwent minimally invasive mitral surgery, both patients died (10). On the other hand, PPM was also reported in patients with mitral valve replacement.…”

Video assisted minimally invasive mitral valve replacement in rheumatic valve disease.

“…In spite of the improvement in healthcare and living standards in recent years, rheumatic fever is still endemic among Egyptian population. Rheumatic valvular lesions are thick and cause calcification and adhesion of valve leaflets, so their surgical manipulation is difficult, in comparison with other pathologies [7]. All our patients had rheumatic mitral valve disease, while previous studies focused mainly on patients having a degenerative disease or mixed pathology.…”

“…[8]. Few recent minimally invasive studies were reported on rheumatic valves; Junyu Zhai, and associates [7], a Chinese study that used thoracoscope for removal the damaged native mitral valve only; Vivek Kanhere and colleagues [9], an Indian study without video assistance and Noedir Antonio and associates [10], a Brazilian study used thoracoscope mainly for commissurotomy of stenotic mitral valve. The procedure was technically feasible in all our cases, with mean operative, ischemic and bypass times that were comparable to those reported by other studies [11].…”