[HSF] Mitral Valve

rwmfglycar at aol.com rwmfglycar at aol.com
Fri May 4 08:42:23 EDT 2007 

Spoilsport!
Bob 
 
-----Original Message-----
From: anianyanwu at hotmail.com
To: OpenHeart-L at lists.hsforum.com
Sent: Fri, 4 May 2007 5:55 AM
Subject: Re: [HSF] Mitral Valve


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.

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