[HSF] Mitral Valve

Fri May 4 18:33:42 EDT 2007

That is something I always wondered.
Prasanna

On 5/4/07, rwmfglycar at aol.com <rwmfglycar at aol.com> wrote:
>
> 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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-- 
Prasanna Simha M