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Shirke MM, Ravikumar N, Shawn TJX, Mutsonziwa N, Soh V, Harky A. Mitral valve surgery via repeat median sternotomy versus right mini-thoracotomy: A systematic review and meta-analysis of clinical outcomes. J Card Surg 2022; 37:4500-4509. [PMID: 36335611 DOI: 10.1111/jocs.17101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 09/14/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Redo mitral valve surgeries have high mortality and morbidity and can be physically demanding for patients. Median sternotomy remains the gold standard for most cardiac surgeries. To tackle certain risks with a re-sternotomy, alternative procedures such as the right anterolateral minithoracotomy have been explored. This review aims to compare the clinical outcomes of re-sternotomy (MS) versus right mini thoracotomy (MT) in mitral valve surgery. METHODS A systematic, electronic search was performed according to Preferred Reporting items for Systematic Reviews and Meta-analysis guidelines to identify relevant articles that compared outcomes of the MS versus MT procedures in patients who have had cardiac surgery via a MS approach. RESULTS Twelve studies were identified, enrolling 4514 patients. Length of hospital stay(MD = -3.71, 95% confidence interval [CI] [-4.92, -2.49]), 30-day mortality(odds ratio [OR] = 0.59, 95% CI [0.39, 0.90]), and new-onset renal failure(OR = 0.38, 95% CI [0.22, 0.65]) were statistically significant in favor of the MT approach. Infection rates(OR = 0.56, 95% CI[0.25, 1.21]) and length of intensive care unit (ICU) stay (MD = -0.55, 95% CI[-1.16, 0.06]) was lower in the MT group; however, the difference was not significant. No significant differences were observed in the CPB time(MD = -2.33, 95% CI [-8.15, 3.50]), aortic cross-clamp time MD = -1.67, 95% CI[-17.07, 13.76]), and rates of stroke(OR = 1.03, 95% CI[0.55, 1.92]). CONCLUSION Right MT is a safe alternative to the traditional re-sternotomy for patients who have had previous cardiac surgery. The approach offers a reduced length of hospital stay, ICU stay, and a lower risk of new-onset renal failure requiring dialysis. This review calls for robust trials in the field to further strengthen the evidence.
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Affiliation(s)
- Manasi Mahesh Shirke
- Department of Medicine, Queen's University Belfast, School of Medicine, Belfast, UK
| | - Nidhruv Ravikumar
- Department of Medicine, Queen's University Belfast, School of Medicine, Belfast, UK
| | - Tan Jia Xiang Shawn
- Department of Medicine, Queen's University Belfast, School of Medicine, Belfast, UK
| | - Nyasha Mutsonziwa
- Department of Medicine, Queen's University Belfast, School of Medicine, Belfast, UK
| | - Vernie Soh
- Department of Medicine, Queen's University Belfast, School of Medicine, Belfast, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest, Liverpool, UK.,Department of Integrative Biology, Faculty of Life Science, University of Liverpool, Liverpool, UK.,Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
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Brown LJ, Mellor SL, Niranjan G, Harky A. Outcomes in minimally invasive double valve surgery. J Card Surg 2020; 35:3486-3502. [PMID: 32906191 DOI: 10.1111/jocs.14997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/08/2020] [Accepted: 08/24/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To review current literature evidence on outcomes of minimally invasive double valve surgeries (MIS). METHODS A comprehensive electronic literature search was done from inception to 20th June 2020 identifying articles that discussed outcomes of minimally invasive approach in double valve surgeries either as a solo cohort or as comparative to conventional sternotomies. No limit was placed on time and place of publication and the evidence has been summarized in narrative manner within the manuscript. RESULTS Majority of current literature reported similar perioperative and clinical outcomes between MIS and conventional median sternotomy; except that MIS has better cosmetic effects and pain control. Nevertheless, minimal invasive techniques are associated with longer cardiopulmonary bypass and aortic cross-clamp times which may have impact on the reported outcomes and overall morbidity and mortality rates. CONCLUSION Minimally invasive double valve surgery continues to develop, but scarcity in the literature suggests uptake is slow, possibly due to the learning curve associated with MIS. Many outcomes appear to be comparable to conventional sternotomy. There is need for larger, multi-center, and randomized trial to fully evaluate and establish the early, mid- and long-term morbidity and mortality rates associated with both techniques.
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Affiliation(s)
- Louise J Brown
- Birmingham Medical School, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Sophie L Mellor
- Birmingham Medical School, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Gunaratnam Niranjan
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest, Liverpool, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest, Liverpool, UK.,Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
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Impact of Lesion Localization on Durability of Mitral Valve Repair in Infective Endocarditis. Ann Thorac Surg 2020; 109:1335-1342. [DOI: 10.1016/j.athoracsur.2019.10.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 10/01/2019] [Accepted: 10/02/2019] [Indexed: 12/15/2022]
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Mohammed H, Yousuf Salmasi M, Caputo M, Angelini GD, Vohra HA. Comparison of outcomes between minimally invasive and median sternotomy for double and triple valve surgery: A meta-analysis. J Card Surg 2020; 35:1209-1219. [PMID: 32306504 DOI: 10.1111/jocs.14558] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 03/31/2020] [Accepted: 04/06/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Limited data exists demonstrating the efficacy of minimally invasive surgery (MIS) compared to median sternotomy (MS) for multiple valvular disease (MVD). This systematic review and meta-analysis aims to compare operative and peri-operative outcomes of MIS vs MS in MVD. METHODS PubMed, Ovid, and Embase were searched from inception until August 2019 for randomized and observational studies comparing MIS and MS in patients with MVD. Clinical outcomes of intra- and postoperative times, reoperation for bleeding and surgical site infection were evaluated. RESULTS Five observational studies comparing 340 MIS vs 414 MS patients were eligible for qualitative and quantitative review. The quality of evidence assessed using the Newcastle-Ottawa scale was good for all included studies. Meta-analysis demonstrated increased cardiopulmonary bypass time for MIS patients (weighted mean difference [WMD], 0.487; 95% confidence interval [CI], 0.365-0.608; P < .0001). Similarly, aortic cross-clamp time was longer in patients undergoing MIS (WMD, 0.632; 95% CI, 0.509-0.755; P < .0001). No differences were found in operative mortality, reoperation for bleeding, surgical site infection, or hospital stay. CONCLUSIONS MIS for MVD have similar short-term outcomes compared to MS. This adds value to the use of minimally invasive methods for multivalvular surgery, despite conferring longer operative times. However, the paucity in literature and learning curve associated with MIS warrants further evidence, ideally randomized control trials, to support these findings.
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Affiliation(s)
- Haya Mohammed
- Faculty of Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Massimo Caputo
- Department of Cardiovascular Sciences, Bristol Heart Institute, University Hospitals Bristol, Bristol, UK
| | - Gianni D Angelini
- Department of Cardiovascular Sciences, Bristol Heart Institute, University Hospitals Bristol, Bristol, UK
| | - Hunaid A Vohra
- Department of Cardiovascular Sciences, Bristol Heart Institute, University Hospitals Bristol, Bristol, UK
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Peng R, Shi H, Ba J, Wang C. Single Femoral Venous Drainage Versus Both Vena Cava Drainage in Isolated Repeat Tricuspid Valve Surgery. Int Heart J 2018; 59:518-522. [PMID: 29681570 DOI: 10.1536/ihj.17-169] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
To assess the potential advantages of minimally invasive surgery using a single femoral venous drainage method versus femoral venous and superior vena cava or jugular venous drainage method during repeat tricuspid valve surgery.From January 2010 to December 2016, 50 repeat tricuspid valve procedures were performed using a minimally invasive approach without aortic cross-clamping at our institution. The arterial cannula was inserted into the femoral artery, and at the same time, the venous cannula was placed in the femoral vein in 28 patients (FV group) during cardiopulmonary bypass (CPB). The venous cannula was inserted into the femoral vein and the superior vena cava or jugular vein in 22 patients (FSV group).Overall, 36 patients underwent tricuspid valve replacement (TVR) and 14 patients underwent tricuspid valvuloplasty (TVP). The CPB time and operation time, respectively, were 72.96 ± 25.90 minutes versus 78.59 ± 31.95 minutes (P = 0.495) and 170.75 ± 73.31 minutes versus 228.87 ± 61.45 minutes (P = 0.004) in the FV group versus the FVS group. There were no significant differences in the ventilator-assisted time, the first-day LVEF, and the intensive care unit (ICU) stay between the FV group and the FSV group.Both types of drainage were effective and could ensure safety during the operative procedure. The vacuum-assisted single femoral venous drainage method simplified the minimally invasive isolated repeat tricuspid valve surgical process more significantly and is the more appropriate choice.
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Affiliation(s)
- Runsheng Peng
- Shanghai Institute of Cardiovascular Disease and Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University
| | - Hui Shi
- Shanghai Institute of Cardiovascular Disease and Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University
| | - Jun Ba
- Shanghai Institute of Cardiovascular Disease and Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University
| | - Chunsheng Wang
- Shanghai Institute of Cardiovascular Disease and Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University
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Dziubek M, Pierrakos C, Chebli L, Demanet H, Sanoussi A, Wauthy P. Para-prosthetic Leaks Following Mitral Valve Replacement: Case Analysis on a 20-year Period. Curr Cardiol Rev 2018; 14:15-24. [PMID: 29141552 PMCID: PMC5872258 DOI: 10.2174/1573403x13666171110110344] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 10/19/2017] [Accepted: 11/03/2017] [Indexed: 11/22/2022] Open
Abstract
Background: Mitral para-prosthetic leaks are rare but major complications of mitral heart valve replacements. When they must be re-operated, they are burdened with high mortality rates. We proposed to review our surgical experience in terms of approach and type of operation carried out. Methods: Demographic, preoperative, intraoperative and postoperative characteristics of 34 patients benefited from a surgical treatment of mitral paravalvular leak, at the Brugmann University Hospital between 1996 and 2016, have been analysed retrospectively. We analysed the data to identify the risk factors of postoperative mortality. We then compared the data depending on the approach and the type of surgical treatment in order to compare the morbidity-mortality. Results: The postoperative mortality rate was 11.7%. The presence of endocarditis and increase in lactate dehydrogenase were predictive factors of mortality. Cardiac complications and acute kidney failure were significantly more common in the decease population. Direct mitral paravalvular leak su-turing was more frequently performed on early apparition, anterior and isolated leaks, whereas a mi-tral heart valve replacement was most often performed to cure active primary endocarditis. The inci-dence of complications and mortality rates were identical according to the approach and the type of operation performed. A mitral para-prosthetic leak recurrence was observed in 33% of the cases. Conclusion: Surgical treatment of mitral para-prosthetic leaks is accompanied by a high mortality rate. The operative strategy plays a major role and can influence the morbidity-mortality encountered in those patients.
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Affiliation(s)
- Melvin Dziubek
- Department of Cardiac Surgery, Brugmann University Hospital, Universite Libre de Bruxelles, Bruxelles, Belgium
| | - Charalampos Pierrakos
- Department of Intensive Care, Brugmann University Hospital, Universite Libre de Bruxelles, Bruxelles, Belgium
| | - Louis Chebli
- Department of Cardiac Surgery, Brugmann University Hospital, Universite Libre de Bruxelles, Bruxelles, Belgium
| | - Helene Demanet
- Department of Cardiac Surgery, Brugmann University Hospital, Universite Libre de Bruxelles, Bruxelles, Belgium
| | - Ahmed Sanoussi
- Department of Cardiac Surgery, Brugmann University Hospital, Universite Libre de Bruxelles, Bruxelles, Belgium
| | - Pierre Wauthy
- Department of Cardiac Surgery, Brugmann University Hospital, Universite Libre de Bruxelles, Bruxelles, Belgium
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Nagendran J, Catrip J, Losenno KL, Adams C, Kiaii B, Chu MW. Minimally invasive mitral repair surgery: why does controversy still persist? Expert Rev Cardiovasc Ther 2016; 15:15-24. [DOI: 10.1080/14779072.2017.1266936] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Jeevan Nagendran
- Division of Cardiac Surgery, Department of Surgery, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - Jorge Catrip
- Department of Cardiovascular Surgery, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico
| | - Katie L. Losenno
- Division of Cardiac Surgery, Department of Surgery, Lawson Health Research Institute, Western University, London, Canada
| | - Corey Adams
- Division of Cardiac Surgery, Department of Surgery, Health Science Center, Memorial University, St. John’s, Canada
| | - Bob Kiaii
- Division of Cardiac Surgery, Department of Surgery, Lawson Health Research Institute, Western University, London, Canada
| | - Michael W.A. Chu
- Division of Cardiac Surgery, Department of Surgery, Lawson Health Research Institute, Western University, London, Canada
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