Port-access surgery as elective approach for mitral valve operation in re-do procedures
| Autor: | Carlo Pellegrini, Alessia Alloni, Mario Viganò, Mauro Rinaldi, Barbara Cattadori, Davide Ricci, Marco Aiello, Andrea Maria D'Armini |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2010 |
| Předmět: |
Pulmonary and Respiratory Medicine
Adult Male Reoperation medicine.medical_specialty Re-operation Sternum medicine.medical_treatment Heart Valve Diseases Video-Assisted Minimally invasive surgery Mitral valve medicine.artery Ascending aorta Atrial Fibrillation medicine 80 and over Humans Minimally Invasive Surgical Procedures Thoracotomy Heart valve Aged Aortic dissection Aged 80 and over Heart Valve Prosthesis Implantation business.industry Thoracic Surgery Video-Assisted Thoracic Surgery Female Intensive Care Units Length of Stay Middle Aged Mitral Valve Treatment Outcome General Medicine medicine.disease Surgery medicine.anatomical_structure Median sternotomy Ventricle Cardiothoracic surgery Anesthesia Cardiology and Cardiovascular Medicine business |
| Popis: | Background: Re-do mitral valve procedures performed through median sternotomy carry substantial mortality and morbidity. To avoid complications of sternal re-entry and to provide adequate mitral valve exposure, antero-lateral thoracotomy has been suggested by some authors. Methods: From October 1997 to January 2007, 677 mitral valve operations have been performed in our centre using port-access videoassisted right mini-thoracotomy. Among these, 241 (35.6%) were performed on patients who had undergone one or more previous cardiac surgery procedures. Results: Mean cardio-pulmonary bypass time and endo-clamp time were 117 46 min and 71 31 min, respectively. Arterial cannulation was performed either on the ascending aorta, with the endo-direct cannula (112 patients, 46.5%), or peripherally with a femoral artery approach (129 patients, 53.5%). Conversion to median sternotomy was necessary in only two patients (0.8%) due to aortic dissection (one case) and left ventricle free wall rupture (one case). Median intensive care unit stay was 24 h, median mechanical ventilation time was 12 h; medianhospitalstaywas8days.Bleedingrequiringsurgicalrevisionoccurredin12patients(4.9%).Hospitalmortalitywas4.9%(12/241patients). Conclusions: Port-access video-assisted right mini-thoracotomy allows good results in a difficult subset of patients; it allows minimal adhesion dissection, short ICU and hospital stay. In our practice, this technique has become the treatment of choice for mitral valve re-do surgery. # 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved. |
| Databáze: | OpenAIRE |
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