[HSF] Mitral Valve

[Ajit Damle]

For your comments, gentlemen.

 

Ajit Damle

 

 

 

ULTRA MINIMALLY INVASIVE MITRAL VALVE SURGERY WITHOUT AORTIC CROSS CLAMP 

Authors: Kumar, S.; Ahmad, R.; Greelish, J.; Petracek, M.; Balaguer, J.; Byrne, J. Source: ANZ Journal of Surgery, Volume 77, Supplement 1, May 2007, pp. A8-A8(1) Publisher: Blackwell Publishing

 

Abstract: 

 

Objective  

 

We developed a technique for mitral valve surgery through an ultra small (5 cm) right lateral thoracotomy without aortic cross clamp. This study reports our combined ST. Thomas and Vanderbilt Heart Institutes five years experience with this technique. 

  

Methods

 

Six hundred and twenty five (316 M /309 F; aged 22-75 mean of 62 years) underwent ultra minimally invasive mitral valve surgery between August 2000 and June 2006. Through a 5 centimeter right lateral thoracotomy along the 4th intercostal space access to the pericardium and the left atrium was gained. Cardiopulmonary bypass was instituted through femoral cannulation. Under cold fibrillatory arrest (28°C) without aortic cross clamp, mitral valve repair (n = 196) or replacement (n = 380), in addition to mitral valve procedure we performed tricuspid valve repair (n = 69), ASD/PFO closure (n = 201) and Maze (n = 156). Mean pre operative New York Heart Association function class was 2.2 ± 0.9. Twenty eight patients had ejection fraction less than 20%.

 

Results  

 

Thirty-day mortality was 1.28% (n = 8), Operating time, bypass time operating averaged 189 ± 52, 113 ± 35 minutes, respectively. Three patients had conversion to sternotomy. Fifteen patients (2.4%) underwent reexploration for bleeding. Average length of hospital stay from surgery to discharge was 6.85 ± 3 days. Ten patients (1.6%) had neurological events. Renal failure required hemodialysis in 5 patients (0.81%). Long term follow-up results are awaited.

 

Conclusions  

 

This study demonstrate that this simplified technique of ultra minimally invasive mitral valve surgery is reproducible and provides the least invasive operative approach with low mortality and morbidity with good cosmetic results.