Minimally Invasive Mitral Valve Surgery Expands the Surgical Options for High-Risks Patients
| Autor: | Stephen K. Ball, Rashid M. Ahmad, Steven J. Hoff, Tarek S. Absi, Michael R. Petracek, Ramanan Umakanthan, Natalia Solenkova, Jorge Balaguer, John G. Byrne, Marzia Leacche |
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| Rok vydání: | 2011 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Heart Valve Diseases New york heart association Young Adult Risk Factors Humans Minimally Invasive Surgical Procedures Medicine In patient Cardiac Surgical Procedures Young adult Aged Aged 80 and over Mitral valve repair Ejection fraction business.industry Middle Aged Surgery Median sternotomy Cohort Mitral Valve Female business Mitral valve surgery |
| Zdroj: | Annals of Surgery. 254:606-611 |
| ISSN: | 0003-4932 |
| Popis: | Background A simplified minimally invasive mitral valve surgery (MIMVS) approach avoiding cross-clamping and cardioplegic myocardial arrest using a small (5 cm) right antero-lateral incision was developed. We hypothesized that, in high-risk patients and in patients with prior sternotomy, this approach would yield superior results compared to those predicted by the Society of Thoracic Surgeons (STS) algorithm for standard median sternotomy mitral valve surgery. Methods Five hundred and four consecutive patients (249 males/255 females), median age 65 years (range 20-92 years) underwent MIMVS between 1/06 and 8/09. Median preoperative New York Heart Association function class was 3 (range 1-4). Eighty-two (16%) patients had an ejection fraction ≤35%. Forty-seven (9%) had a STS predicted mortality ≥10%. Under cold fibrillatory arrest (median temperature 28°C) without aortic cross-clamp, mitral valve repair (224/504, 44%) or replacement (280/504, 56%) was performed. Results Thirty-day mortality for the entire cohort was 2.2% (11/504). In patients with a STS predicted mortality ≥ 10% (range 10%-67%), the observed 30-day mortality was 4% (2/47), lower than the mean STS predicted mortality of 20%. Morbidity in this high-risk group was equally low: 1 of 47 (2%) patients underwent reexploration for bleeding, 1 of 47 (2%) patients suffered a permanent neurologic deficit, none had wound infection. The median length of stay was 8 days (range 1-68 days). Conclusions This study demonstrates that MIMVS without aortic cross-clamp is reproducible with low mortality and morbidity rates. This approach expands the surgical options for high-risk patients and yields to superior results than the conventional median sternotomy approach. |
| Databáze: | OpenAIRE |
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