Outcomes in minimally invasive double valve surgery

Abstract

Objective: To review current literature evidence on outcomes of minimally invasive double valve surgeries (MIS). Methods: A comprehensive electronic literature search was done from inception to 20th June 2020 identifying articles that discussed outcomes of minimally invasive approach in double valve surgeries either as a solo cohort or as comparative to conventional sternotomies. No limit was placed on time and place of publication and the evidence has been summarized in narrative manner within the manuscript. Results: Majority of current literature reported similar perioperative and clinical outcomes between MIS and conventional median sternotomy; except that MIS has better cosmetic effects and pain control. Nevertheless, minimal invasive techniques are associated with longer cardiopulmonary bypass and aortic cross-clamp times which may have impact on the reported outcomes and overall morbidity and mortality rates. Conclusion: Minimally invasive double valve surgery continues to develop, but scarcity in the literature suggests uptake is slow, possibly due to the learning curve associated with MIS. Many outcomes appear to be comparable to conventional sternotomy. There is need for larger, multi-center, and randomized trial to fully evaluate and establish the early, mid-and long-term morbidity and mortality rates associated with both techniques. K E Y W O R D S cardiac surgery, double valve, minimal access, minimal invasive 1 | INTRODUCTION Minimally invasive surgery (MIS) is a rapidly evolving technique for valvular pathologies, which has seen an increase in adoption over the last 24 years due to its popularization by Navia and Crosgrove. 1 The conventional median sternotomy (MS) has been the standard approach for decades, due to good exposure of the surgical field and more surgical experience with the technique, but MIS has gained more acceptance. The uptake has been slow in the past, possibly due to the learning curve reported and previous lack of established training programmes, but the outcomes reported have been at least as good, if not better, than MS. 2 In single valve surgery, MIS has been shown to have cosmetic, respiratory and blood product use advantages over MS, amongst many other benefits. 3,4 However, longer operation times have been reported for MIS. 5 In the USA, multiple valve surgery accounts for 3%-25% of all valve surgeries annually, 6 yet few studies have focussed on a minimally invasive approach for double valve surgery, with even less directly comparing MIS to MS. We reviewed the current literature to evaluate the outcomes of a minimally invasive approach to double valve surgery.

µAVR: Endoscopic Microinvasive Aortic Valve Surgery With Automated Suturing Technology for Enhanced Patient Outcomes

“…The early perception regarding minimally invasive cardiac surgical techniques was often associated with a steep learning curve, narrow field of vision, and tight working spaces, along with longer CPB and aortic cross-clamping durations; such potential risk for patients can be ameliorated with advanced technology and techniques. 9…”

“…The early perception regarding minimally invasive cardiac surgical techniques was often associated with a steep learning curve, narrow field of vision, and tight working spaces, along with longer CPB and aortic cross-clamping durations; such potential risk for patients can be ameliorated with advanced technology and techniques. 9 The learning curve for the µAVR procedure is dependent mostly on the enthusiasm and experience of the surgeon. Those who have experience with small access sites, videoscopic imaging, and peripheral cannulation-from, for example, minimally invasive mitral valve surgery-should be able to acclimate to this approach within 5 to 10 cases.…”

Treatment of chronic mini-thoracotomy wound pain and lung herniation with intercostal cryoablation and surgical mesh repair: a case report

“…However, it also has some disadvantages. The duration of anesthesia and surgery can be prolonged due to technical di culties, and the detection of accidental trouble can be delayed because of the limited surgical eld of view [9]. These issues can be improved with increased surgeon experience.…”

Implementation of Endoscopic Minimally Invasive Mitral Valve Replacement Surgery With Automated Suturing Technology

“… 11 However, advancements in technology, particularly automated suturing devices, have begun to alleviate some of these concerns. 12 A multicenter study by Malvindi et al highlighted a notable reduction in CPB and cross-clamp times when employing less invasive mitral valve procedures via infra-axillary access, compared with traditional minimally invasive techniques. 4 Our own experience corroborates these findings; the integration of automated suturing technologies such as the RAM and SEW EASY devices has streamlined the surgical process, enabling rapid and reliable suture placement even in confined remote surgical spaces.…”