[HSF] Mitral Valve

[Ani Anyanwu]

It always intrigues me how people get away with misrepresenting data. Surgeons particularly have a thing about exaggerating size or lack of size.

Now tell me how can all mitrals be done through a 5 cm incision? To say so means this group measured all skin incisions and they were all 5 cm. Highly unlikely. All humans are different and it is impossible that the same operation, indeed any operation, is carried out in every individual with same sized incision. Even more interesting is that a 5 cm incision spreads to a diameter of approximately 3cm, hardly enough to even introduce a large valve prosthesis.

This year we have reoperated on 3 patients who had early failure of mini-invasive mitrals (one at a reputable center). I measured all the thoracotomy scars and the smallest was 13cm. One of the patients even believes she had a robotic mitral. I have one good picture which shows that our reoperative sternotomy scar was shorter in length than the right thoracotomy scar.

Selling thoracotomy mitrals as minimally invasive is one of the greatest scandals of current day cardiac surgery. While there are some who do a truly minimally invasive approach (small incision, non-rib spreading, endoscopes, robots etc), many just do a thoracotomy and sell it as minimally invasive.

As for 5cm incision in ALL patients, all sizes, all body habitus, all pathologies? Do they think we are stupid? Anyone who says they do this should show me the data - measure all skin incisions and in the paper I want to see the median and interquartile range for scar length. You will be surprised what you see and I suspect most of these 5cm incisions were closer to 10 or even 15 cm than to 5 cm.

Ani
  ----- Original Message ----- 
  From: Ajit Damle<mailto:damle at cableone.net> 
  To: OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com> 
  Sent: Tuesday, May 01, 2007 4:08 AM
  Subject: [HSF] Mitral Valve


  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.

  _______________________________________________
  OpenHeart-L mailing list

  Send postings to:
   OpenHeart-L at lists.hsforum.com<mailto:OpenHeart-L at lists.hsforum.com>

  To UNSUBSCRIBE, to CHANGE email address, or to view archives:
  http://mmp.cjp.com/mailman/listinfo/openheart-l<http://mmp.cjp.com/mailman/listinfo/openheart-l>

  All messages transmitted by the OpenHeart-L are subject to the policies and 
  disclaimers posted at:
  http://www.hsforum.com/listdisclaim<http://www.hsforum.com/listdisclaim>
  -----------------------------------------