[HSF] Mitral Valve

[prasannasimha]

Isn't this what Fredrick Mohr is doing ?
My one worry with all these methods is the replacement of the safer 
aortic cannulation with a riskier femoral cannulation. Also non cross 
clamp continuous fibrillation while being old hat is a pain even with 
minimal AR.
Prasanna
Ajit Damle wrote:
> For your comments, gentlemen.
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> Ajit Damle
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> ULTRA MINIMALLY INVASIVE MITRAL VALVE SURGERY WITHOUT AORTIC CROSS CLAMP 
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> 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
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> Abstract: 
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> Objective  
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> 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. 
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> Methods
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> 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%.
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> Results  
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> 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.
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> Conclusions  
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> 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.
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