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Yoo JS, Kim JB, Jung SH, Choo SJ, Chung CH, Lee JW. Echocardiographic assessment of mitral durability in the late period following mitral valve repair: minithoracotomy versus conventional sternotomy. J Thorac Cardiovasc Surg 2013; 147:1547-52. [PMID: 23856209 DOI: 10.1016/j.jtcvs.2013.05.042] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 04/24/2013] [Accepted: 05/10/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the long-term echocardiographic mitral valve (MV) durability after MV repair performed through a minithoracotomy versus conventional sternotomy. METHODS A total of 299 patients who underwent MV repair for degenerative mitral regurgitation (MR) through minithoracotomy (n = 179) or sternotomy (n = 120), between April 2004 and January 2010, were evaluated. To adjust the differences in baseline characteristics between the 2 groups, weighted Cox proportional-hazards regression models and inverse-probability-of-treatment weighting were used. RESULTS There were no 30-day deaths in both groups and no significant differences in early complication rates. Clinical follow-up was complete in 294 patients (98.3%), with a median follow-up of 55.4 months (interquartile range, 34.4-66.9 months), during which there were 10 late deaths, 2 strokes, and 3 reoperations for recurrent MR. After adjustment, the minithoracotomy group had similar risks for major adverse cardiac events (hazard ratio, 0.77; 95% confidence interval, 0.22-2.68; P = .68). Echocardiographic evaluation in the late period (>6 months) was possible in 292 patients (97.7%), with a median follow-up of 29.4 months (interquartile range, 13.3-49.7 months), during which 21 patients (12 in the minithoracotomy group and 9 in the sternotomy group) experienced significant MR (>2+). Freedom from significant MR at 5 years was 86.1% ± 4.8% versus 85.3% ± 5.5% (P = .63). After adjustment, the minithoracotomy group had similar risks for significant MR (hazard ratio, 0.81; 95% confidence interval, 0.31-2.14; P = .67). CONCLUSIONS A minithoracotomy approach for MV repair showed comparable clinical outcomes and efficacy to conventional sternotomy for MV repair.
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Affiliation(s)
- Jae Suk Yoo
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea
| | - Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea
| | - Sung-Ho Jung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea
| | - Suk Jung Choo
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea
| | - Cheol Hyun Chung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea
| | - Jae Won Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea.
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Cho DS, Linte C, Chen ECS, Bainbridge D, Wedlake C, Moore J, Barron J, Patel R, Peters T. Predicting target vessel location on robot-assisted coronary artery bypass graft using CT to ultrasound registration. Med Phys 2013; 39:1579-87. [PMID: 22380390 DOI: 10.1118/1.3684958] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Although robot-assisted coronary artery bypass grafting (RA-CABG) has gained more acceptance worldwide, its success still depends on the surgeon's experience and expertise, and the conversion rate to full sternotomy is in the order of 15%-25%. One of the reasons for conversion is poor pre-operative planning, which is based solely on pre-operative computed tomography (CT) images. In this paper, the authors propose a technique to estimate the global peri-operative displacement of the heart and to predict the intra-operative target vessel location, validated via both an in vitro and a clinical study. METHODS As the peri-operative heart migration during RA-CABG has never been reported in the literatures, a simple in vitro validation study was conducted using a heart phantom. To mimic the clinical workflow, a pre-operative CT as well as peri-operative ultrasound images at three different stages in the procedure (Stage(0)-following intubation; Stage(1)-following lung deflation; and Stage(2)-following thoracic insufflation) were acquired during the experiment. Following image acquisition, a rigid-body registration using iterative closest point algorithm with the robust estimator was employed to map the pre-operative stage to each of the peri-operative ones, to estimate the heart migration and predict the peri-operative target vessel location. Moreover, a clinical validation of this technique was conducted using offline patient data, where a Monte Carlo simulation was used to overcome the limitations arising due to the invisibility of the target vessel in the peri-operative ultrasound images. RESULTS For the in vitro study, the computed target registration error (TRE) at Stage(0), Stage(1), and Stage(2) was 2.1, 3.3, and 2.6 mm, respectively. According to the offline clinical validation study, the maximum TRE at the left anterior descending (LAD) coronary artery was 4.1 mm at Stage(0), 5.1 mm at Stage(1), and 3.4 mm at Stage(2). CONCLUSIONS The authors proposed a method to measure and validate peri-operative shifts of the heart during RA-CABG. In vitro and clinical validation studies were conducted and yielded a TRE in the order of 5 mm for all cases. As the desired clinical accuracy imposed by this procedure is on the order of one intercostal space (10-15 mm), our technique suits the clinical requirements. The authors therefore believe this technique has the potential to improve the pre-operative planning by updating peri-operative migration patterns of the heart and, consequently, will lead to reduced conversion to conventional open thoracic procedures.
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Affiliation(s)
- Daniel S Cho
- The University of Western Ontario, Ontario, Canada.
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Abstract
The transition of mitral valve surgery away from the traditional sternotomy approach toward more minimally invasive strategies continues to evolve. The use of telemanipulative robotic arms with near 3-dimensional valve visualization has allowed for near complete endoscopic robotic-assisted mitral valve surgery, providing increased patient satisfaction and cosmesis. Studies have shown rapid recovery times without sacrificing perioperative safety or the durability of surgical repair. Although a steep learning curve exists as well as high fixed and disposable costs, continued technological development fueled by increasing patient demand may allow for further expansion in the use of robotic-assisted minimal invasive surgery.
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Affiliation(s)
- William Vernick
- Department of Anesthesiology and Critical Care, The Perelman School of Medicine at the University Hosptial of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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Goldstone AB, Atluri P, Szeto WY, Trubelja A, Howard JL, MacArthur JW, Newcomb C, Donnelly JP, Kobrin DM, Sheridan MA, Powers C, Gorman RC, Gorman JH, Pochettino A, Bavaria JE, Acker MA, Hargrove WC, Woo YJ. Minimally invasive approach provides at least equivalent results for surgical correction of mitral regurgitation: a propensity-matched comparison. J Thorac Cardiovasc Surg 2013; 145:748-56. [PMID: 23414991 DOI: 10.1016/j.jtcvs.2012.09.093] [Citation(s) in RCA: 121] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 08/22/2012] [Accepted: 09/12/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Minimally invasive approaches to mitral valve surgery are increasingly used, but the surgical approach must not compromise the clinical outcome for improved cosmesis. We examined the outcomes of mitral repair performed through right minithoracotomy or median sternotomy. METHODS Between January 2002 and October 2011, 1011 isolated mitral valve repairs were performed in the University of Pennsylvania health system (455 sternotomies, 556 right minithoracotomies). To account for key differences in preoperative risk profiles, propensity scores identified 201 well-matched patient pairs with mitral regurgitation of any cause and 153 pairs with myxomatous disease. RESULTS In-hospital mortality was similar between propensity-matched groups (0% vs 0% for the degenerative cohort; 0% vs 0.5%, P = .5 for the overall cohort; in minimally invasive and sternotomy groups, respectively). Incidence of stroke, infection, myocardial infarction, exploration for postoperative hemorrhage, renal failure, and atrial fibrillation also were comparable. Transfusion was less frequent in the minimally invasive groups (11.8% vs 20.3%, P = .04 for the degenerative cohort; 14.0% vs 22.9%, P = .03 for the overall cohort), but time to extubation and discharge was similar. A 99% repair rate was achieved in patients with myxomatous disease, and a minimally invasive approach did not significantly increase the likelihood of a failed repair resulting in mitral valve replacement. Patients undergoing minimally invasive mitral repair were more likely to have no residual post-repair mitral regurgitation (97.4% vs 92.1%, P = .04 for the degenerative cohort; 95.5% vs 89.6%, P = .02 for the overall cohort). In the overall matched cohort, early readmission rates were higher in patients undergoing sternotomies (12.6% vs 4.4%, P = .01). Over 9 years of follow-up, there was no significant difference in long-term survival between groups (P = .8). CONCLUSIONS In appropriate patients with isolated mitral valve disease of any cause, a right minithoracotomy approach may be used without compromising clinical outcome.
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Affiliation(s)
- Andrew B Goldstone
- Department of Surgery, Division of Cardiovascular Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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McClure RS, Athanasopoulos LV, McGurk S, Davidson MJ, Couper GS, Cohn LH. One thousand minimally invasive mitral valve operations: Early outcomes, late outcomes, and echocardiographic follow-up. J Thorac Cardiovasc Surg 2013; 145:1199-206. [DOI: 10.1016/j.jtcvs.2012.12.070] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 12/08/2012] [Accepted: 12/18/2012] [Indexed: 10/27/2022]
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Outcomes of minimally invasive mitral valve surgery in patients with an ejection fraction of 35% or less. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2013; 8:1-5. [PMID: 23571786 DOI: 10.1097/imi.0b013e31828da226] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We evaluated the outcomes of minimally invasive mitral valve surgery via a right anterior thoracotomy approach in patients with isolated severe mitral regurgitation and severely reduced left ventricular systolic function. METHODS We retrospectively reviewed all minimally invasive mitral valve surgeries for mitral regurgitation in patients with an ejection fraction of 35% or less performed at our institution between December 2008 and June 2011. The operative times, lengths of stay, postoperative complications, and mortality were analyzed. RESULTS We identified a total of 71 patients with severe mitral regurgitation and an ejection fraction of 35% or less who underwent minimally invasive mitral valve surgery. The mean ± SD age was 67 ± 10 years, and 44 of the patients were men (62%). The mean ± SD left ventricular ejection fraction was 27% ± 6%, and 28 patients (39%) had previous heart surgery. The median aortic cross-clamp and cardiopulmonary bypass times were 62 [interquartile range (IQR), 50-80) and 98 minutes (IQR, 92-124), respectively. There was no mitral regurgitation noted in any patient on postoperative transesophageal echocardiogram. The median intensive care unit length of stay was 51 hours (IQR, 42-86), and the median postoperative length of stay was 6 days (IQR, 5-9). CONCLUSIONS Minimally invasive mitral valve surgery for severe functional mitral regurgitation in patients with severe left ventricular dysfunction can be performed with a low morbidity and mortality.
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Minimally Invasive Edge-to-Edge Mitral Repair With or Without Artificial Chordae. Ann Thorac Surg 2013; 95:1347-53. [DOI: 10.1016/j.athoracsur.2012.12.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2012] [Revised: 12/07/2012] [Accepted: 12/10/2012] [Indexed: 11/23/2022]
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Lucà F, van Garsse L, Rao CM, Parise O, La Meir M, Puntrello C, Rubino G, Carella R, Lorusso R, Gensini GF, Maessen JG, Gelsomino S. Minimally invasive mitral valve surgery: a systematic review. Minim Invasive Surg 2013; 2013:179569. [PMID: 23606959 PMCID: PMC3625540 DOI: 10.1155/2013/179569] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 02/07/2013] [Accepted: 02/17/2013] [Indexed: 12/04/2022] Open
Abstract
In the recent years minimally invasive mitral valve surgery (MIMVS) has become a well-established and increasingly used option for managing patients with a mitral valve pathology. Nonetheless, whether the purported benefits of MIMVS translate into clinically important outcomes remains controversial. Therefore, in this paper we provide an overview of MIMVS and discuss results, morbidity, mortality, and quality of life following mitral minimally invasive procedures. MIMVS has been proven to be a feasible alternative to the conventional full sternotomy approach with low perioperative morbidity and short-term mortality. Reported benefits of MIMVS include also decreased postoperative pain, improved postoperative respiratory function, reduced surgical trauma, and greater patient satisfaction. Finally, compared to standard surgery, MIMVS demonstrated comparable efficacy across a range of long-term efficacy measures such as freedom from reoperation and long-term survival.
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Affiliation(s)
- Fabiana Lucà
- Cardiothoracic and Cardiology Department, Maastricht University, The Netherlands
- Heart and Vessels Department, Careggi Hospital, Florence, Italy
- Cardiology Department, Paolo Borsellino Hospital, Marsala, Italy
| | - Leen van Garsse
- Cardiothoracic and Cardiology Department, Maastricht University, The Netherlands
| | | | - Orlando Parise
- Heart and Vessels Department, Careggi Hospital, Florence, Italy
| | - Mark La Meir
- Cardiothoracic and Cardiology Department, Maastricht University, The Netherlands
| | | | - Gaspare Rubino
- Cardiology Department, Paolo Borsellino Hospital, Marsala, Italy
| | - Rocco Carella
- Heart and Vessels Department, Careggi Hospital, Florence, Italy
| | - Roberto Lorusso
- Heart and Vessels Department, Careggi Hospital, Florence, Italy
| | | | - Jos G. Maessen
- Cardiothoracic and Cardiology Department, Maastricht University, The Netherlands
| | - Sandro Gelsomino
- Cardiothoracic and Cardiology Department, Maastricht University, The Netherlands
- Heart and Vessels Department, Careggi Hospital, Florence, Italy
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Obase K, Komeda M, Saito K, Tamada T, Fukuhara K, Koyama T, Kume T, Hayashida A, Okura H, Yoshida K. Visualization of Submitral Structure by Three-Dimensional Transesophageal Echocardiography. Echocardiography 2013; 30:945-51. [DOI: 10.1111/echo.12154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Affiliation(s)
| | | | - Ken Saito
- Kawasaki Medical School; Kurashiki; Japan
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260
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Bridgewater B. Almanac 2012: Adult cardiac surgery. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2013; 83:64-71. [PMID: 23453923 DOI: 10.1016/j.acmx.2013.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 01/15/2013] [Indexed: 11/19/2022] Open
Affiliation(s)
- Ben Bridgewater
- University Hospital of South Manchester, Manchester, United Kingdom.
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261
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Bridgewater B. Almanac 2012 adult cardiac surgery: The national society journals present selected research that has driven recent advances in clinical cardiology. Egypt Heart J 2013. [DOI: 10.1016/j.ehj.2012.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Ahmad Shah Z, Ahangar AG, Ganie FA, Wani ML, Lone H, Wani N, Wani SN, Muzamil I, Gani M. Comparison of right anterolateral thorocotomy with standard median steronotomy for mitral valve replacement. Int Cardiovasc Res J 2013; 7:15-20. [PMID: 24757613 PMCID: PMC3987419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 11/19/2012] [Accepted: 12/17/2012] [Indexed: 11/17/2022] Open
Abstract
OBEJECTIVES The objectives of this study were to compare and analyze the results of right anterolateral thoracotomy and median sternotomy approach for primary mitral valve replacement with reference to the exposure during Valve Replacement , length of surgical incision, mean cross clamp time, mean bypass time, intensive care unit (ICU) stay, hospitalization, overall comorbidity with sternotomy; sepsis, dehiscence, healing cosmetic issues and cost effectiveness. METHODS The present study comprised 68 patients with rheumatic mitral valve disease who underwent mitral valve replacement in the Department ofCardiovascular and Thoracic Surgery at Sher‑i‑Kashmir Institute of Medical Sciences from September 2009 to August 2011. RESULTS This study comprised 64 patients with 23 (35.9%) males and 41 (64.1%) females. Sternotomy group had 10 males (31.3%) and 22 females (68.7%). Thoracotomy group had 13 males (40.6%) and 19(59.4%) females. The length of incision between the two groups was statistically significant (P<0.0001). Mean incision length were 24.6±2.1 cm and 14.8±2.3 cm in sternotomy and thoracotomy respectively. Statistically significant difference regarding duration of ICU stay was found between the two groups (P<0.0001). Scar visibility was 100% in sternotomy and around 25% in thoracotomy( P<0.0001). CONCLUSIONS Thoracotomy through a right anterolateral aspect was easy to perform while maintaining maximum security for the patients. Besides its satisfactory cosmetic result especially in female patients, this approach proved to have several advantages. It offers a better exposure to the mitral apparatus even in patients with small left, allowing easy mitral valve replacement which is apparent from the lower cross‑clamp time in the test group. The invaluable advantage of the above- mentioned thoracotomy is total eradication of the risk of deep sternal infection. The shorter hospital stay and cost effectiveness of thoracotomy approach are additional relief to the family.
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Affiliation(s)
- Zamir Ahmad Shah
- Department of cardiovascular and thoracic surgery, SKIMS, Soura, Kashmir , India
| | - Abdual Gani Ahangar
- Department of cardiovascular and thoracic surgery, SKIMS, Soura, Kashmir , India
| | - Farooq Ahmad Ganie
- Department of cardiovascular and thoracic surgery, SKIMS, Soura, Kashmir , India,Corresponding author: Farooq Ahmad Ganie, Cardiovascular and Thoracic Surgery, SKIMS, Soura Srinagar, Kashmir, India. Tel: +94-69064259, E-mail:
| | - Mohd Lateef Wani
- Department of cardiovascular and thoracic surgery, SKIMS, Soura, Kashmir , India
| | - Hafeezulla Lone
- Department of cardiovascular and thoracic surgery, SKIMS, Soura, Kashmir , India
| | - Nasiruddin Wani
- Department of cardiovascular and thoracic surgery, SKIMS, Soura, Kashmir , India
| | - Shadab Nabi Wani
- Department of cardiovascular and thoracic surgery, SKIMS, Soura, Kashmir , India
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263
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Woo YJ, MacArthur JW. Posterior ventricular anchoring neochordal repair of degenerative mitral regurgitation efficiently remodels and repositions posterior leaflet prolapse. Eur J Cardiothorac Surg 2013; 44:485-9; discussion 489. [PMID: 23449863 DOI: 10.1093/ejcts/ezt092] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Mitral valve repair techniques for degenerative disease typically entail leaflet resection or neochordal construction, which may require extensive resection, leaflet detachment/reattachment, reliance on diseased native chords or precise neochordal measuring. Occasionally, impaired leaflet mobility, reduced coaptation surface and systolic anterior motion (SAM) may result. We describe a novel technique for addressing posterior leaflet prolapse/flail, which both simplifies repair and addresses these issues. METHODS Fifty-four patients (age 62 ± 11 years) with degenerative MR underwent this new repair, 36 of whom minimally-invasively. A CV5 Gore-Tex suture was placed into the posterior left ventricular myocardium underneath the prolapsing segment as an anchor. This suture was then used to imbricate a portion of the prolapsed segment into the ventricle, creating a smooth, broad, non-prolapsed coapting surface on a leaflet with preserved mobility, additional neochordal support and posteriorly positioned enough to preclude SAM. RESULTS Repair was successful in all patients. The mean MR grade was reduced from +3.8 to +0.1 with 50 of 54 patients having zero MR and 4 of the 54 having trace or mild MR. All patients had proper antero-posterior location of the coaptation line of a mean length of 10.2 mm, and preserved posterior leaflet mobility. No patients had SAM or mitral stenosis. All patients were discharged and are currently doing well. CONCLUSION This new technique facilitated efficient single-suture repair of the prolapsed posterior leaflet mitral regurgitation without the need for resection or sliding annuloplasty. It precluded the need for precise neochordal measurement and preserved the leaflet coaptation surface.
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Affiliation(s)
- Y Joseph Woo
- Department of Surgery, Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, PA 19104, USA.
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264
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Krapf C, Wohlrab P, Haussinger S, Schachner T, Hangler H, Grimm M, Muller L, Bonatti J, Bonaros N. Remote access perfusion for minimally invasive cardiac surgery: to clamp or to inflate? Eur J Cardiothorac Surg 2013; 44:898-904. [DOI: 10.1093/ejcts/ezt070] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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Murzi M, Cerillo AG, Miceli A, Bevilacqua S, Kallushi E, Farneti P, Solinas M, Glauber M. Antegrade and retrograde arterial perfusion strategy in minimally invasive mitral-valve surgery: a propensity score analysis on 1280 patients. Eur J Cardiothorac Surg 2013; 43:e167-72. [DOI: 10.1093/ejcts/ezt043] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bridgewater B. Almanac 2012: adult cardiac surgery: the national society journals present selected research that has driven recent advances in clinical cardiology. Rev Port Cardiol 2013; 32:173-80. [PMID: 23369506 DOI: 10.1016/j.repc.2012.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 11/15/2012] [Indexed: 11/17/2022] Open
Abstract
This review covers the important publications in adult cardiac surgery in the last few years, including the current evidence base for surgical revascularisation and the use of off-pump surgery, bilateral internal mammary arteries and endoscopic vein harvesting. The changes in conventional aortic valve surgery are described alongside the outcomes of clinical trials and registries for transcatheter aortic valve implantation, and the introduction of less invasive and novel approaches of conventional aortic valve replacement surgery. Surgery for mitral valve disease is also considered, with particular reference to surgery for asymptomatic degenerative mitral regurgitation.
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267
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Bridgewater B. Almanac 2012: Adult cardiac surgery: The national society journals present selected research that has driven recent advances in clinical cardiology. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2013. [DOI: 10.1016/j.repce.2013.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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268
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Santana O, Reyna J, Pineda AM, Mihos CG, Elkayam LU, Lamas GA, Lamelas J. Outcomes of Minimally Invasive Mitral Valve Surgery in Patients with an Ejection Fraction of 35% or Less. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2013. [DOI: 10.1177/155698451300800101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Orlando Santana
- Division of Cardiac Surgery at Mount Sinai Heart Institute, Miami Beach, FL USA
| | - Javier Reyna
- Division of Cardiac Surgery at Mount Sinai Heart Institute, Miami Beach, FL USA
| | - Andres M. Pineda
- Division of Cardiac Surgery at Mount Sinai Heart Institute, Miami Beach, FL USA
| | - Christos G. Mihos
- Division of Cardiac Surgery at Mount Sinai Heart Institute, Miami Beach, FL USA
| | - Lior U. Elkayam
- Division of Cardiac Surgery at Mount Sinai Heart Institute, Miami Beach, FL USA
| | - Gervasio A. Lamas
- Division of Cardiac Surgery at Mount Sinai Heart Institute, Miami Beach, FL USA
| | - Joseph Lamelas
- Division of Cardiac Surgery at Mount Sinai Heart Institute, Miami Beach, FL USA
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Endocardites: nouveautés, pièges et controverses. MEDECINE INTENSIVE REANIMATION 2013. [DOI: 10.1007/s13546-012-0539-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Vollroth M, Seeburger J, Mohr FW. Reply to Saleh et al. Eur J Cardiothorac Surg 2012; 43:1275. [PMID: 23230150 DOI: 10.1093/ejcts/ezs617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Early Results of Edge-to-Edge Alfieri Mitral Repair Via Right Mini-Thoracotomy in 68 Consecutive Patients. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2012; 4:256-60. [PMID: 22437164 DOI: 10.1097/imi.0b013e3181bba05e] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE : To examine early outcomes of mitral valve repair using Alfieri repair via a right mini-thoracotomy approach. METHODS : Records were examined in 68 consecutive patients undergoing Alfieri mitral repair via 6 cm right mini-thoracotomy. Most repairs were performed under cardioplegic arrest, using percutaneous femoral cannulation and direct aortic cannulation through the right first intercostal space. All patients without hypertrophic cardiomyopathy received rigid ring annuloplasty. The indications for Alfieri repair were extensive prolapse with ring size at least 30 mm. RESULTS : Mean age was 56 ± 13 (range, 20-80). Mitral disease etiology was Barlow disease in 17 of 68 (25%) patients and myxomatous disease in 47 of 68 (69%). Concurrent procedures were performed in 29 of 68 (43%) patients. Median ring size was 34 mm. Despite extensive leaflet disease, 59 of 68 (87%) patients were repaired without leaflet resection. Chord pairs were inserted on the posterior leaflet in 18 of 68 (26%) patients and anterior leaflet in four patients. There were no 30-day or late deaths. Residual intraoperative mitral regurgitation was absent in 54 of 68 (79%) patients and trace in the remainder. Local echocardiography follow-up at a mean of 99 days showed median residual regurgitation to be trace. Only two patients developed moderate regurgitation. Mean mitral gradient at follow-up was 4 ± 2 mm Hg. Local follow-up showed 28 of 39 (72%) patients to be New York Heart Association class I. CONCLUSIONS : An edge-to-edge Alfieri repair via mini-thoracotomy can provide excellent short-term results in selected patients with complex myxomatous mitral disease when minimizing the need for leaflet resection.
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Clinical results of minimally invasive mitral valve surgery: endoaortic clamp versus external aortic clamp techniques. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2012; 4:311-8. [PMID: 22437227 DOI: 10.1097/imi.0b013e3181c490e5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE : This study was carried out with the aim of presenting our experience with minimally invasive mitral surgery and compare the endoaortic clamp with the external aortic clamp (EAC) techniques. METHODS : Between December 2002 and May 2009, 139 patients (75 men, aged 63 ± 11 years) underwent video-assisted mitral valve surgery through right thoracotomy. Twelve (9%) patients were operated without clamping the aorta, 32 (23%) patients (group A) were operated on by using the endoaortic clamp, and 95 (68%) patients were operated on by using the EAC (group B). There was no significant difference between groups A and B regarding preoperative variables. RESULTS : Intraoperative procedure-associated problems were experienced in three group A patients (9.3%, two aortic dissections with conversion to sternotomy; one conversion due to bad exposure) and in two group B patients (2%, one conversion to sternotomy for bleeding and one for ascending aorta hematoma). At a mean follow-up of 32 months, 121 patients (97%) were in New York Heart Association class I-II, with satisfactory echocardiographic results. There was one in-hospital and six late deaths (three noncardiac, two cardiac, and one valve related). Five-year actuarial survival was 88% ± 8%. There were three reoperations, one early (<30 days) after complex mitral valve repair, with a 5-year freedom from reoperation of 97% ± 2%. Postoperative levels of myocardial cytonecrosis enzymes as well as the extracorporeal circulation time were significantly lower in group B patients (P < 0.05). CONCLUSIONS : Intraoperative procedure-associated complications with endoclamping combined with an apparently better myocardial protection forced us to change our practice to the more simple and economic EAC technique.
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274
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Staged percutaneous coronary intervention and minimally invasive valve surgery: Results of a hybrid approach to concomitant coronary and valvular disease. J Thorac Cardiovasc Surg 2012; 144:634-9. [PMID: 22154788 DOI: 10.1016/j.jtcvs.2011.11.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Revised: 09/27/2011] [Accepted: 11/07/2011] [Indexed: 01/29/2023]
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275
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Glower DD. Surgical approaches to mitral regurgitation. J Am Coll Cardiol 2012; 60:1315-22. [PMID: 22939558 DOI: 10.1016/j.jacc.2011.11.081] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 11/17/2011] [Accepted: 11/22/2011] [Indexed: 10/27/2022]
Abstract
Surgical approaches to correct mitral regurgitation (MR) have evolved over 50 years and form much of the basis for percutaneous approaches to the mitral valve. Surgical mitral repairs have been more durable with use of annuloplasty, but recurrent regurgitation not resulting in reoperation can occur. The mitral leaflets may be resected or augmented, with recent trends to preserve leaflet coaptation surfaces if possible. Mitral chords tend to be replaced or transferred instead of being shortened. Mitral replacement still has a role when more durable and reliable than repair. Surgical incisions have varied from full sternotomy down to percutaneous access only, with less invasiveness usually requiring a trade-off versus effectiveness or ease of application. Less invasive options in treating MR may encourage higher-risk patients to seek anatomic therapy, whether surgical or percutaneous. Rapidly evolving technology will continue to be a dominant driver of surgical approaches to MR, with increasing overlap and interaction with percutaneous approaches.
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Affiliation(s)
- Donald D Glower
- Department of Surgery, Duke University, Durham, North Carolina 27710, USA.
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276
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277
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Ten Years’ Follow-Up of Single-Surgeon Minimally Invasive Reparative Surgery for Degenerative Mitral Valve Disease. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2012; 7:270-3. [DOI: 10.1097/imi.0b013e31826f7ac4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective Granted that minimally invasive mitral valve (MV) surgery short-term results were found to be equivalent to those achieved with traditional sternotomy with respect to perioperative morbidity and echocardiographic outcomes, little is known about the long-term efficacy of this approach. This report analyzes a 10-year single-surgeon experience with minimally invasive MV surgery through a right minithoracotomy with peripheral cannulation and external aortic cross-clamping and MV repair (MVR) by direct vision. Methods We studied 179 patients (48% female) who underwent MVR between December 1999 and December 2010. Mean age was 40.2 ± 10.1 years (range, 15–67 years). One hundred seventy patients (95.0%) had degenerative diseases, and nine patients (5.0%) had endocarditic diseases. Repair techniques for degenerative disease with posterior leaflet prolapse (74 patients, 43.5%) consisted of quadrangular resection (QR) and annuloplasty (AP) combined with sliding plasty (49 patients, 58.1%); for anterior leaflet prolapse (28 patients, 16.5%) and bileaflet prolapse (66 patients, 38.8%), edge-to-edge repair (EE) and AP; in 2 patients (1.2%), annular dilatation alone consisting of AP. Repair techniques for endocarditic disease consisted of EE in six patients (66.7%), perforation closure in two patients (22.2%), and QR combined with AP in one patient (11.1%). Results All patients survived the operation and were discharged with MV regurgitation (MR) less than 2+/4+. At 10 years’ follow-up, overall survival was 98.7% ± 1.2%, freedom from redo was 98.5% ± 1.1%, freedom from MR recurrence (>2+/4+) in QR and in EE repair were, respectively, 91.7% ± 2.2% and 90.0% ± 2.4% (P = not significant). The linearized rates of overall mortality, MR recurrence (>2+/4+), and redo at follow-up are 0.10% ± 0.10% per year, 0.63% ± 0.26% per year, and 0.21% ± 0.15% per year, respectively. Conclusions Minimally invasive MVR can be performed with very good perioperative and long-term results. Freedom from MR greater than 2+/4+ recurrence for patients with QR is equivalent to that with EE repair in our patient cohort.
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278
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D'Alfonso A, Capestro F, Zingaro C, Matteucci S, Rescigno G, Torracca L. Ten Years’ Follow-Up of Single-Surgeon Minimally Invasive Reparative Surgery for Degenerative Mitral Valve Disease. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2012. [DOI: 10.1177/155698451200700407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Filippo Capestro
- Division of Cardiac Surgery, Presidio Lancisi, Ospedali Riuniti, Ancona, Italy
| | - Carlo Zingaro
- Division of Cardiac Surgery, Presidio Lancisi, Ospedali Riuniti, Ancona, Italy
| | - Sacha Matteucci
- Division of Cardiac Surgery, Presidio Lancisi, Ospedali Riuniti, Ancona, Italy
| | - Giuseppe Rescigno
- Division of Cardiac Surgery, Presidio Lancisi, Ospedali Riuniti, Ancona, Italy
| | - Lucia Torracca
- Division of Cardiac Surgery, Presidio Lancisi, Ospedali Riuniti, Ancona, Italy
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279
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Panos A, Myers PO. Video-assisted cardiac myxoma resection: basket technique for complete and safe removal from the heart. Ann Thorac Surg 2012; 93:e109-10. [PMID: 22450108 DOI: 10.1016/j.athoracsur.2011.11.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Revised: 10/13/2011] [Accepted: 11/07/2011] [Indexed: 10/28/2022]
Abstract
Video assistance can replace sternotomy in cardiac operations with excellent results. Because myxomas are very friable tumors, their removal from the heart and chest cavity through a working port in video-assisted or robotic procedures may be challenging. We used a laparoscopic basket to safely catch and remove these friable tumors in 10 patients undergoing video-assisted myxoma resection between December 2008 and June 2011. Complete excision and removal was achieved in all patients. No neurologic, vascular, or wound complications were observed. This minimally invasive myxoma technique gives excellent and reproducible results without a higher risk for the patient.
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Affiliation(s)
- Aristotelis Panos
- Department of Cardiovascular Surgery, Hygeia Hospital, Athens, Greece.
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Santana O, Reyna J, Benjo AM, Lamas GA, Lamelas J. Outcomes of minimally invasive valve surgery in patients with chronic obstructive pulmonary disease. Eur J Cardiothorac Surg 2012; 42:648-52. [PMID: 22555309 DOI: 10.1093/ejcts/ezs098] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES We hypothesize that minimally invasive valve surgery in patients with chronic obstructive pulmonary disease (COPD) is superior to the conventional median sternotomy approach. METHODS We retrospectively reviewed 2846 consecutive surgery performed at our institution between January 2005 and September 2010, and identified 165 patients with COPD who underwent isolated valve surgery. In-hospital mortality, composite complication rates, intensive care unit and total hospital length of stay of those who had undergone a minimally invasive approach were compared with a cohort that underwent a standard median sternotomy approach. RESULTS Of the 165 patients, 100 underwent a minimally invasive approach and 65 had a median sternotomy. Baseline characteristics did not differ between the two groups. The mean age was 71 ± 11 years for the minimally invasive group and 68 ± 12 years for the median sternotomy group, (P = 0.31). In-hospital mortality was 1 (1%) in the minimally invasive group and 3 (5%) in the median sternotomy group, P = 0.14. Composite postoperative complications were significantly reduced in the minimally invasive group (30 versus 54%, P = 0.002). The median intensive care unit length of stay was 47 h (IQR 40-70) versus 73 h (IQR 51-112), P < 0.001, and the median postoperative length of stay was 6 days (IQR 5-9) versus 9 days (IQR 7-13), P < 0.001, for the minimally invasive and the median sternotomy groups, respectively. CONCLUSIONS Minimally invasive valve surgery in patients with COPD is associated with excellent short-term results, and thus should be considered an option in these patients.
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Affiliation(s)
- Orlando Santana
- Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL 33140, USA.
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281
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Stevens LM, Rodriguez E, Lehr EJ, Kindell LC, Nifong LW, Ferguson TB, Chitwood WR. Impact of Timing and Surgical Approach on Outcomes After Mitral Valve Regurgitation Operations. Ann Thorac Surg 2012; 93:1462-8. [DOI: 10.1016/j.athoracsur.2012.01.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 11/06/2011] [Accepted: 01/09/2012] [Indexed: 11/30/2022]
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282
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Suri RM, Antiel RM, Burkhart HM, Huebner M, Li Z, Eton DT, Topilsky T, Sarano ME, Schaff HV. Quality of life after early mitral valve repair using conventional and robotic approaches. Ann Thorac Surg 2012; 93:761-9. [PMID: 22364970 DOI: 10.1016/j.athoracsur.2011.11.062] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2011] [Revised: 11/21/2011] [Accepted: 11/23/2011] [Indexed: 01/05/2023]
Abstract
BACKGROUND Early mitral valve (MV) repair of degenerative mitral regurgitation is associated with superior clinical outcomes compared with prosthetic replacement and restores normal life expectancy, even in those without symptoms. Although current guidelines recommend prompt referral for effective MV repair in those with severe mitral regurgitation, some are reluctant to pursue early correction due to the perception that short-term quality of life (QOL) may be adversely affected by the operation. METHODS Between January 2008 and November 2009, 202 patients underwent conventional transsternotomy or minimally invasive port-access robot-assisted MV repair, with or without patent foramen ovale closure or left Maze, and were mailed a postsurgical QOL survey. RESULTS Unadjusted QOL scores for patients undergoing MV repair were excellent early after the operation using both approaches. Robotic repair was associated with slightly improved scores on the Duke Activity Status Index, the Short Form-12 Item Health Survey Physical domain, and the Linear Analogue Self-Assessment frequency of chest pain and fatigue indices during the first postoperative year; however, differences between treatment groups became indistinguishable after 1 year. Robotic repair patients returned to work slightly quicker (median, 33 vs 54 days, p<0.001). CONCLUSIONS Functional QOL outcomes within the first 2 years after early MV repair are excellent using open and robotic platforms. A robotic approach may be associated with slightly improved early QOL and return to employment-based activities. These results may have implications regarding future evolution of clinical guidelines and economic health care policy.
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Affiliation(s)
- Rakesh M Suri
- Division of Cardiovascular Surgery, Mayo Medical School, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota 55905, USA.
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283
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Iribarne A, Easterwood R, Russo MJ, Chan EY, Smith CR, Argenziano M. Comparative effectiveness of minimally invasive versus traditional sternotomy mitral valve surgery in elderly patients. J Thorac Cardiovasc Surg 2012; 143:S86-90. [DOI: 10.1016/j.jtcvs.2011.10.090] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Revised: 09/12/2011] [Accepted: 10/05/2011] [Indexed: 10/28/2022]
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284
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Banayan J, Dhawan R, Vernick WJ, McCarthy PM. CASE 3--2012. Iatrogenic circumflex artery injury during minimally invasive mitral valve surgery. J Cardiothorac Vasc Anesth 2012; 26:512-9. [PMID: 22459930 DOI: 10.1053/j.jvca.2012.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Indexed: 11/11/2022]
Affiliation(s)
- Jennifer Banayan
- Department of Anesthesia and Critical Care, University of Chicago Medical Center, Chicago, IL 60637, USA.
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285
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Yaffee DW, Galloway AC, Grossi EA. Editorial analysis: impact of perfusion strategy on stroke risk for minimally invasive cardiac surgery. Eur J Cardiothorac Surg 2012; 41:1223-4. [PMID: 22430175 DOI: 10.1093/ejcts/ezs022] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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286
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Murzi M, Cerillo AG, Bevilacqua S, Gasbarri T, Kallushi E, Farneti P, Solinas M, Glauber M. Enhancing departmental quality control in minimally invasive mitral valve surgery: a single-institution experience. Eur J Cardiothorac Surg 2012; 42:500-6. [PMID: 22427391 DOI: 10.1093/ejcts/ezs050] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES In recent years, there has been an increasing interest in monitoring the quality of cardiac surgical performance. The aim of the present study was to apply control charts (CUSUM curves) to monitor the performance of minimally invasive mitral valve procedures to enhance quality control for that operation. METHODS A total of 936 minimally invasive mitral valve procedures were performed from September 2003 to March 2011 by seven surgeons (range 26-401 procedures) at a single institution. Institutional and individual surgeons' performances were monitored using descriptive statistics and control charts, with a predetermined acceptable failure rate of 10% and calculated 80% alert and 95% alarm lines. Perioperative death or one or more of seven adverse events constituted failure. RESULTS The incidence of in-hospital mortality was 1.8% (17/936) and compared favourably with the predicted mortality (logistic EuroSCORE 7.3%). Institutional CUSUM analysis revealed an initial learning curve and then the surgical process remained in control for all the study period. There were differences between surgeons with regard to the learning curves and perioperative complications (7.3-11.3%, P = 0.9). Five surgeons crossed the 95% reassurance boundary between operations 23 and 48. One surgeon crossed the 95% reassurance boundary after 116 operations. No surgeon crossed the 95% alarm line, which indicates unacceptably high failure rates. CONCLUSIONS Minimally invasive mitral surgery can be safely performed with low morbidity and mortality. CUSUM curve analysis is a simple statistical method to implement continuous individual and departmental performance monitoring.
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Affiliation(s)
- Michele Murzi
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Massa, Italy
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287
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Vistarini N, Aiello M, Viganò M. Minimally invasive video-assisted cardiac surgery: operative techniques, application fields and clinical outcomes. Future Cardiol 2012; 7:775-87. [PMID: 22050064 DOI: 10.2217/fca.11.57] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Minimally invasive video-assisted surgery through a right minithoracotomy has become the standard surgical approach for several cardiac diseases at many major centers worldwide. In this article we review the existing literature on the subject and describe different operative techniques, application fields and clinical outcomes.
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Affiliation(s)
- Nicola Vistarini
- Division of Cardiac Surgery, Dipartimento di Scienze Chirurgiche, Rianimatorie, Riabilitative e dei Trapianti D'Organo, Fondazione IRCCS Policlinico San Matteo, Pavia University School of Medicine, Italy.
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Abstract
Despite improvements in medical and surgical therapies, infective endocarditis is associated with poor prognosis and remains a therapeutic challenge. Many factors affect the outcome of this serious disease, including virulence of the microorganism, characteristics of the patients, presence of underlying disease, delays in diagnosis and treatment, surgical indications, and timing of surgery. We review the strengths and limitations of present therapeutic strategies and propose future directions for better management of endocarditis according to the most recent research. Novel perspectives on the management of endocarditis are emerging and offer hope for decreasing the rate of residual deaths by accelerating the process of diagnosis and risk stratification, reducing delays in starting antimicrobial therapy, rapid transfer of high-risk patients to specialised medico-surgical centres, development of new surgical methods, and close long-term follow-up.
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Affiliation(s)
- Franck Thuny
- Département de Cardiologie, Hôpital de La Timone, AP-HM, Aix-Marseille University, Marseille, France; Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), CNRS UMR 6236, Faculté de Médecine, Aix-Marseille University, Marseille, France
| | - Dominique Grisoli
- Département de Chirurgie Cardiaque, Hôpital de La Timone, AP-HM, Aix-Marseille University, Marseille, France
| | - Frederic Collart
- Département de Chirurgie Cardiaque, Hôpital de La Timone, AP-HM, Aix-Marseille University, Marseille, France
| | - Gilbert Habib
- Département de Cardiologie, Hôpital de La Timone, AP-HM, Aix-Marseille University, Marseille, France
| | - Didier Raoult
- Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), CNRS UMR 6236, Faculté de Médecine, Aix-Marseille University, Marseille, France.
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Hussain S, Adams C, Mechulan A, Leong-Sit P, Kiaii B. Minimally invasive robotically assisted repair of atrial perforation from a pacemaker lead. Int J Med Robot 2012; 8:243-6. [PMID: 22368148 DOI: 10.1002/rcs.459] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2011] [Indexed: 11/07/2022]
Abstract
BACKGROUND We present the first reported case of robotic-assisted right atrial perforation repair and pacemaker lead extraction. METHODS A 75-year-old female with symptomatic sinus node dysfunction underwent atrial single chamber permanent pacemaker insertion via a persistent left superior vena cava approach. At one week follow-up a chest radiograph and a computerized dynamic tomography demonstrated that the right atrial lead had perforated the right atrial free wall. The patient remained asymptomatic without signs of pericardial tamponade, however urgent repair was warranted. RESULTS Utilizing the da Vinci robotic system (Intuitive Surgical Inc., Sunnyvale, California, USA), the pacer lead perforation was visualized, the lead retracted, and the right atrium repaired. The existing atrial lead was repositioned in the right atrial appendage. CONCLUSION The patient's postoperative convalescence was uneventful, and she was discharged home on the third post-operative day. This case demonstrates the increasing clinical utilization of robotic-assisted technology in minimally invasive cardiac surgery.
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Affiliation(s)
- Sara Hussain
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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290
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Vernick WJ, Woo JY. Anesthetic considerations during minimally invasive mitral valve surgery. Semin Cardiothorac Vasc Anesth 2012; 16:11-24. [PMID: 22361820 DOI: 10.1177/1089253211434591] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Advances in instruments and visualization tools as well as circulatory systems for cardiopulmonary bypass during the late 1990s have stimulated widespread adoption of minimally invasive mitral valve surgery (MIMVS). Today, MIMVS is the standard approach for many surgeons and institutions. There are multiple benefits of MIMVS. Patient satisfaction and improved cosmesis are important. Additionally, studies have consistently shown faster recovery times and less associated pain with MIMVS. Statistically significant improvement in bleeding, transfusion, incidence of atrial fibrillation, and time to resumption of normal activities with MIMVS has also been shown when comparing MIMVS with conventional mitral surgery. Most important, these benefits have been achieved without sacrificing perioperative safety or durability of surgical repair. Although a steep learning curve still exists given the high level of case complexity, continued development fueled by increasing patient demand may allow for even further expansion in the use of minimal invasive techniques.
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Affiliation(s)
- William J Vernick
- Department of Anesthesia and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
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291
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Athanasiou T, Ashrafian H, Rowland SP, Casula R. Robotic cardiac surgery: advanced minimally invasive technology hindered by barriers to adoption. Future Cardiol 2012; 7:511-22. [PMID: 21797747 DOI: 10.2217/fca.11.40] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Robotic cardiac surgery utilizes the most advanced surgical technology to offer patients a minimally invasive alternative to open surgery in the treatment of a broad range of cardiac pathologies. Although robotics may offer substantial benefits to physicians, patients and healthcare institutions, there are important barriers to its adoption that includes inadequate funding, competition from alternate therapies and challenges in training. There is a growing body of evidence to demonstrate the efficacy of robotic cardiac surgery. Technological innovations are improving patient safety and expanding the indications for robotic cardiac surgery beyond the treatment of mitral valve and coronary artery disease. Robotic cardiac surgery is rapidly becoming a feasible, safe and effective option for the definitive treatment of cardiac disease in the context of 21st century challenges to healthcare provision such as diabetes, obesity and an aging population.
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Affiliation(s)
- Thanos Athanasiou
- Department of Surgery & Cancer, Imperial College London, London W2 1NY, UK.
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292
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293
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Swaans MJ, Post MC, van der Ven HAJ, Heijmen RH, Budts W, ten Berg JM. Transapical treatment of paravalvular leaks in patients with a logistic euroscore of more than 15%. Catheter Cardiovasc Interv 2012; 79:741-7. [DOI: 10.1002/ccd.23264] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 05/27/2011] [Indexed: 12/23/2022]
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294
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Santana O, Lamelas J. Minimally invasive transaortic repair of the mitral valve. Heart Surg Forum 2012; 14:E232-6. [PMID: 21859641 DOI: 10.1532/hsf98.20101133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE We retrospectively evaluated the results of an edge-to-edge repair (Alfieri stitch) of the mitral valve performed via a transaortic approach in patients who were undergoing minimally invasive aortic valve replacement. METHODS From January 2010 to September 2010, 6 patients underwent minimally invasive edge-to-edge repair of the mitral valve via a transaortic approach with concomitant aortic valve replacement. The patients were considered to be candidates for this procedure if they were deemed by the surgeon to be high-risk for a double valve procedure and if on preoperative transesophageal echocardiogram the mitral regurgitation jet originated from the middle portion (A2/P2 segments) of the mitral valve. RESULTS There was no operative mortality. Mean cardiopulmonary bypass time was 137 minutes, and mean cross-clamp time was 111 minutes. There was a significant improvement in the mean mitral regurgitation grade, with a mean of 3.8 preoperatively and 0.8 postoperatively. The ejection fraction remained stable, with mean preoperative and postoperative ejection fractions of 43.3% and 47.5%, respectively. Follow-up transthoracic echocardiograms obtained at a mean of 33 days postoperatively (range, 8-108 days) showed no significant worsening of mitral regurgitation. CONCLUSION Transaortic repair of the mitral valve is feasible in patients undergoing minimally invasive aortic valve replacement.
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Affiliation(s)
- Orlando Santana
- Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL 33140, USA.
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295
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Chan EY, Lumbao DM, Iribarne A, Easterwood R, Yang JY, Cheema FH, Smith CR, Argenziano M. Evolution of Cannulation Techniques for Minimally Invasive Cardiac Surgery a 10-Year Journey. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2012. [DOI: 10.1177/155698451200700103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Edward Y. Chan
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY USA
| | - Dennis M. Lumbao
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY USA
| | - Alexander Iribarne
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY USA
| | - Rachel Easterwood
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY USA
| | - Jonathan Y. Yang
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY USA
| | - Faisal H. Cheema
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY USA
| | - Craig R. Smith
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY USA
| | - Michael Argenziano
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY USA
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296
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Bonnichsen CR, Burkhart HM, Klarich KW, Suri RM. Surgical Resection of Mitral Valve Papillary Fibroelastoma: A Robot-Assisted, Minimally Invasive Approach with Three-Dimensional Transesophageal Echocardiography Imaging. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/wjcs.2012.22004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Chan EY, Lumbao DM, Iribarne A, Easterwood R, Yang JY, Cheema FH, Smith CR, Argenziano M. Evolution of Cannulation Techniques for Minimally Invasive Cardiac Surgery a 10-Year Journey. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2012; 7:9-14. [DOI: 10.1097/imi.0b013e318253369a] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective For minimally invasive cardiac surgery (MICS) procedures requiring cardiopulmonary bypass (CPB), cannulation techniques vary and seem to be important determinants of technical difficulty and clinical outcomes. Over 10 years of MICS, we have modified our techniques substantially, and the present report outlines the evolution of our current cannulation platform. Methods From October 2000 to November 2010, 1087 minimally invasive cardiac procedures were performed at our institution; of these, 165 were done without CPB and were excluded. Methods of arterial and venous cannulation and aortic occlusion were retrospectively reviewed. Outcomes of interest included CPB and aortic cross-clamp time, as well as rates of in-hospital stroke, myocardial infarction, and short- and long-term mortality. Results The mean age of the study population was 57 ± 15 years, with 50% being men. The MICS procedures included mitral valve surgery, atrial septal defect repair, atrial fibrillation ablation, and cardiac tumor resections. Over the study period, peripheral arterial cannulation was replaced by central aortic cannulation, which was used in 33% of patients in 2000–2001 and 93% in 2008–2010. Venous cannulation strategies also evolved over time, from percutaneous neck and femoral (78% of cases from 2000–2005), to direct superior vena cava and percutaneous femoral (67% in 2006–2007), to percutaneous dual-stage femoral (51% in 2008–2010). Aortic occlusion was achieved by endoaortic balloon in 33% of cases in 2000–2001 but, by 2002, was replaced by transaxillary clamp occlusion and direct antegrade/retrograde cardioplegia. In the post-endoballoon era, CPB and cross-clamp times have remained consistent. Overall, there were nine strokes (<1.0%), no myocardial infarctions, and 18 deaths (2.0%) within 30 days of surgery, and the incidence of these outcomes has not changed over time. Conclusions Over 10 years, our cannulation strategy for MICS has evolved to favor central aortic over femoral arterial cannulation, percutaneous femoral dual-stage bicaval venous drainage over percutaneous neck access, and transaxillary clamping over endoaortic balloon occlusion of the aorta. In our experience, this approach has resulted in low complication rates and a reliable platform for a variety of MICS procedures.
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Affiliation(s)
- Edward Y. Chan
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY USA
| | - Dennis M. Lumbao
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY USA
| | - Alexander Iribarne
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY USA
| | - Rachel Easterwood
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY USA
| | - Jonathan Y. Yang
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY USA
| | - Faisal H. Cheema
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY USA
| | - Craig R. Smith
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY USA
| | - Michael Argenziano
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY USA
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Seeburger J, Katus HA, Pleger ST, Krumsdorf U, Mohr FW, Bekeredjian R. Percutaneous and surgical treatment of mitral valve regurgitation. DEUTSCHES ARZTEBLATT INTERNATIONAL 2011; 108:816-21. [PMID: 22211148 DOI: 10.3238/arztebl.2011.0816] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Accepted: 04/18/2011] [Indexed: 12/21/2022]
Abstract
BACKGROUND Mitral valve regurgitation is the second most common clinically relevant valvular heart disease in adults, with an incidence of about 2% to 3% per year. Surgical mitral valve repair is the treatment of choice. Recent years have seen major advances in minimally invasive mitral valve surgery. Several new catheter-based techniques are now being clinically evaluated, including percutaneous endovascular mitral valve repair with a mitral clip. METHOD This review is based on a selective review of the literature and on the authors' clinical experience. RESULTS Minimally invasive and reconstructive techniques for mitral valve surgery have come into more common use in recent years. In Germany, more than 50% of all mitral valve defects are now treated with a valve-preserving repair procedure. At the same time, percutaneous techniques have been developed that enable reduction of mitral regurgitation in the cardiac catheterization laboratory, without surgery. The implantation of a mitral clip is the sole currently approved technique of this type. In a recently published, randomized comparative clinical trial (EVEREST II), it was found to be safer, but less effective, than surgery. CONCLUSION Mitral valve surgery remains the treatment of choice for severe mitral regurgitation. For patients at high risk from surgery, and particularly those with severe heart failure, the implantation of a mitral clip is a safe and feasible treatment option.
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Affiliation(s)
- Joerg Seeburger
- Abteilung für Herzchirurgie, Herzzentrum Universität Leipzig
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300
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Minimally Invasive Mitral Valve Surgery Expands the Surgical Options for High-Risks Patients. Ann Surg 2011; 254:606-11. [DOI: 10.1097/sla.0b013e3182300399] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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