SD closures and Re: [HSF] Mitral Valve
hgrmd at aol.com
hgrmd at aol.com
Fri May 4 16:43:40 EDT 2007
Jean,
Actually, all of those things can be robotically with a 20 mm working port. I didn't believe it until I'd seen and done it myself.
Hal
-----Original Message-----
From: jean.bachet at imm.fr
To: OpenHeart-L at lists.hsforum.com
Sent: Fri, 4 May 2007 8:31 AM
Subject: SD closures and Re: [HSF] Mitral Valve
Dear ani,
any surgeon normally active, experienced and sensible, must fully agree with
your comments. When I read the abstract about minimally invasive mitral surgery
and that "5cm" thoracotomy , I had exactly your reaction. Do they think we are
stupid? or ignorant? I dared not to write any comment as I did not want to be
considered as an "ugly French moralist" once again. You did the job and did it
perfectly. BRAVO.
By the way, I notice that the authors state that, in addition to the mitral
repair, they have performed 69 tricuspid repairs, 201 ASD closures and 156 Maze
procedures. This implies the opening of the right atrium. I would be very
curious to see (and to be taught, if possible) how they cannulate, snare and
control the venae cavae, open the RA and do the job through their tiny incision
(which represents 2 thirds of a regular cigarette length!!!)
It reminds me the famous reply made by Jean Hagen (playing a Hollywood movie
star of the thirties) when discussing her contract with the producer in the
very famous musical " Singing in the rain " by Stanley Donen and Gene Kelly.
" What do you think I am: a dumb, or something??".
Jean Bachet.
----- Original Message -----
From: "Ani Anyanwu" <anianyanwu at hotmail.com>
To: <OpenHeart-L at lists.hsforum.com>
Sent: Friday, May 04, 2007 11:55 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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