Minimally invasive mitral valve surgery is a very safe procedure with very low rates of conversion to full sternotomy

Vollroth, Marcel; Seeburger, Joerg; Garbade, Jens; Pfannmueller, Bettina; Holzhey, David; Misfeld, Martín; Borger, Michael A.; Mohr, Friedrich W.

doi:10.1093/ejcts/ezs195

Cited by 53 publications

(31 citation statements)

References 12 publications

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“…Eleven patients (4.4%) were intraoperatively converted to full sternotomy (5 due to bleeding, 3 pulmonary adhesions, 1 failure to cannulate the femoral vein, 1 type A aortic dissection, 1 iatrogenic aortic regurgitation). This is in line with other studies reporting major bleeding and severe pulmonary adhesions to be the most common reason for conversion to full sternotomy [64]. No patient died within 30 days of surgery.…”

Section: Discussionsupporting

confidence: 92%

Minimally invasive mitral valve surgery is associated with a low rate of complications

et al. 2019

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Minimally invasive mitral valve surgery is generally performed through a right minithoracotomy, in contrast to the traditional full median sternotomy approach. Minimally invasive mitral valve surgery is performed with increasing frequency, and by reducing surgical trauma, several observational studies suggest potential benefits with decreased bleeding and postoperative pain, reduced incidence of sternal wound infections, reduced length of hospital stay and shortened recovery period after surgery. In this review, we present an overview of mitral valve surgery, summarize the available evidence regarding the minimally invasive approach and report our experiences from introducing a minimally invasive mitral valve surgery programme at the Karolinska University Hospital in Stockholm, Sweden.

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Section: Discussionsupporting

confidence: 92%

Minimally invasive mitral valve surgery is associated with a low rate of complications

et al. 2019

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“…In circumstances where adequate exposure cannot be obtained, the minimally invasive surgery may need to be converted to a standard median sternotomy. Although data for double valve surgery are scarce, the conversion rate of minimally invasive surgery to median sternotomy is 1.0-4.0% during single valve operations (24,25). In the present study, even though 9.4% underwent re-operative surgery, adequate exposure was obtained in all patients, and none required conversion to a median sternotomy.…”

Section: Discussioncontrasting

confidence: 44%

Outcomes of minimally invasive double valve surgery

et al. 2017

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Background: Double valve surgery is associated with an increased peri-operative morbidity and mortality.A less invasive right thoracotomy approach may be a viable alternative to median sternotomy surgery in these higher-risk patients. Methods: We retrospectively analyzed the baseline demographics, operative characteristics, and postoperative outcomes of patients who underwent minimally invasive double valve surgery between January 2009 and December 2011 at our institution. Results: The cohort consisted of 117 patients, of which 68 (58.1%) were female. The mean age was 73±11 years, and the mean left ventricular ejection fraction was 52±11%. There were 43 (36.8%) patients with a history of congestive heart failure, 45 (38.5%) with chronic obstructive pulmonary disease, and 5 (4.3%) had a history of chronic kidney disease. The patients underwent primary (90.6%) or re-operative (9.4%) double valve surgery, which consisted of 50 (42.7%) aortic valve replacement and mitral valve repair, 31 (26.5%) mitral and tricuspid valve repair, 18 (15.4%) aortic and mitral valve replacement, 17 (14.5%) mitral valve replacement with tricuspid valve repair, and 1 (0.9%) aortic valve replacement with tricuspid valve repair.Post-operatively, there were 40 (34.2%) cases of prolonged ventilation, 9 (7.7%) acute kidney injury, 6 (5.1%) re-operations for bleeding, 1 (0.9%) cerebrovascular accident, and 15 (12.8%) cases of atrial fibrillation. The mean total hospital length of stay was 12±12 days, with an in-hospital mortality of 2 (1.7%).Conclusions: A minimally invasive right thoracotomy approach to primary or re-operative double valve surgery is feasible, may be utilized with acceptable peri-operative morbidity and mortality.

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“…The conversion rate of minimally invasive surgery to full median sternotomy is 1.0%-4.0% during single valve procedure, but data for conversion rate of minimally invasive multi-valve surgery to full median sternotomy were very rare. 30,31) In the present study, adequate exposure of operative filed was obtained in all patients, and no patients required conversion to a median sternotomy.…”

Section: Discussionmentioning

confidence: 57%

Combined Mitral and Aortic Valve Procedure via Right Mini-Thoracotomy versus Full Median Sternotomy

et al. 2019

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Data involving combined mitral and aortic valve procedure via the right mini-thoracotomy approach are very limited. This single-center propensity-matching study aimed to evaluate early clinical outcomes of patients who underwent combined mitral and aortic valve procedure via right mini-thoracotomy versus full median sternotomy.From January 2013 to December 2016, 926 eligible patients in our center were identified for this study. After propensity score-matching, 91 pairs of patients were entered into a RT group (right mini-thoracotomy surgery) or a FS group (full median sternotomy surgery). In-hospital and follow-up clinical outcomes were investigated and analyzed.Patients in the RT group received similar surgical mortality as patients in the FS group (1.1% versus 2.2%, P > 0.05). Patients in the RT group as compared with the FS group were less likely to receive postoperative new onset of atrial fibrillation and red cell transfusion (11.0% versus 25.3%, P = 0.012; 17.6% versus 37.4%, P = 0.003, respectively), but they shared similar incidences of other major postoperative morbidity. Patients in the RT group as compared with the FS group experienced 6-minute longer aortic cross-clamping times and 9minute longer cardiopulmonary bypass times, but received shorter intensive care unit stay and postoperative hospitalization time. No repeat valve operation, peri-prosthetic leak, or moderate or severe mitral valve regurgitation following valvuloplasty were observed in either group before discharge and also within one year of surgery.In primary, isolated, combined mitral and aortic valve procedure, a right mini-thoracotomy approach may be utilized with accepted early clinical outcomes, and may be considered as a feasible alternative to the approach of full median sternotomy.(Int Heart J 2019; 60: 336-344)

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Minimally invasive mitral valve surgery is a very safe procedure with very low rates of conversion to full sternotomy

Cited by 53 publications

References 12 publications

Minimally invasive mitral valve surgery is associated with a low rate of complications

Minimally invasive mitral valve surgery is associated with a low rate of complications

Outcomes of minimally invasive double valve surgery

Combined Mitral and Aortic Valve Procedure via Right Mini-Thoracotomy versus Full Median Sternotomy

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