1
|
Larsson M, Nozohoor S, Ede J, Herou E, Ragnarsson S, Wierup P, Zindovic I, Sjögren J. Biomarkers of inflammation and coagulation after minimally invasive mitral valve surgery: a prospective comparison to conventional surgery. SCAND CARDIOVASC J 2024; 58:2347293. [PMID: 38832868 DOI: 10.1080/14017431.2024.2347293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 04/20/2024] [Indexed: 06/06/2024]
Abstract
OBJECTIVES Minimally invasive cardiac surgery techniques are increasingly used but have longer cardiopulmonary bypass time, which may increase inflammatory response and negatively affect coagulation. Our aim was to compare biomarkers of inflammation and coagulation as well as transfusion rates after minimally invasive mitral valve repair and mitral valve surgery using conventional sternotomy. DESIGN A prospective non-randomized study was performed enrolling 71 patients undergoing mitral valve surgery (35 right mini-thoracotomy and 36 conventional sternotomy procedures). Blood samples were collected pre- and postoperatively to assess inflammatory response. Thromboelastometry (ROTEM) was performed to assess coagulation, and transfusion rates were monitored. RESULTS The minimally invasive group had longer cardiopulmonary bypass times compared to the sternotomy group: 127 min ([115-146] vs 79 min [65-112], p < 0.001) and were cooled to a lower temperature during cardiopulmonary bypass, 34 °C vs 36 °C (p = 0.04). IL-6 was lower in the minimally invasive group compared to the conventional sternotomy group when measured at the end of the surgical procedure, (38 [23-69] vs 61[41-139], p = 0.008), but no differences were found at postoperative day 1 or postoperative day 3. The transfusion rate was lower in the minimally invasive group (14%) compared to full sternotomy (35%, p = 0.04) and the chest tube output was reduced, (395 ml [190-705] vs 570 ml [400-1040], p = 0.04). CONCLUSIONS Our data showed that despite the longer use of extra corporal circulation during surgery, minimally invasive mitral valve repair is associated with reduced inflammatory response, lower rates of transfusion, and reduced chest tube output.
Collapse
Affiliation(s)
- Mårten Larsson
- Department of Cardiothoracic and Vascular Surgery, Lund University and Skåne University Hospital, Lund, Sweden
| | - Shahab Nozohoor
- Department of Cardiothoracic and Vascular Surgery, Lund University and Skåne University Hospital, Lund, Sweden
| | - Jacob Ede
- Department of Cardiothoracic and Vascular Surgery, Lund University and Skåne University Hospital, Lund, Sweden
| | - Erik Herou
- Section for Pediatric Cardiac Surgery, Department of Pediatrics, Lund University and Childrens Hospital, Skåne University Hospital, Lund, Sweden
| | - Sigurdur Ragnarsson
- Department of Cardiothoracic and Vascular Surgery, Lund University and Skåne University Hospital, Lund, Sweden
- Department of Cardiac Surgery, Yale University and Yale University Hospital, New Haven, USA
| | - Per Wierup
- Department of Cardiothoracic and Vascular Surgery, Lund University and Skåne University Hospital, Lund, Sweden
| | - Igor Zindovic
- Department of Cardiothoracic and Vascular Surgery, Lund University and Skåne University Hospital, Lund, Sweden
| | - Johan Sjögren
- Department of Cardiothoracic and Vascular Surgery, Lund University and Skåne University Hospital, Lund, Sweden
| |
Collapse
|
2
|
Motoyoshi N, Tsutsui M, Soman K, Shirasaka T, Narita T, Kunioka S, Naya K, Yamazaki D, Narita M, Kamiya H. Neuron-specific enolase levels immediately following cardiovascular surgery is modulated by hemolysis due to cardiopulmonary bypass, making it unsuitable as a brain damage biomarker. J Artif Organs 2024; 27:100-107. [PMID: 37120686 PMCID: PMC11126439 DOI: 10.1007/s10047-023-01398-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 04/15/2023] [Indexed: 05/01/2023]
Abstract
Neuron-specific enolase (NSE) is one of the biomarkers used as an indicator of brain disorder, but since it is also found in blood cell components, there is a concern that a spurious increase in NSE may occur after cardiovascular surgery, where cardiopulmonary bypass (CPB) causes hemolysis. In the present study, we investigated the relationship between the degree of hemolysis and NSE after cardiovascular surgery and the usefulness of immediate postoperative NSE values in the diagnosis of brain disorder. A retrospective study of 198 patients who underwent surgery with CPB in the period from May 2019 to May 2021 was conducted. Postoperative NSE levels and Free hemoglobin (F-Hb) levels were compared in both groups. In addition, to verify the relationship between hemolysis and NSE, we examined the correlation between F-Hb levels and NSE levels. We also examined whether different surgical procedures could produce an association between hemolysis and NSE. Among 198 patients, 20 had postoperative stroke (Group S) and 178 had no postoperative stroke (Group U). There was no significant difference in postoperative NSE levels and F-Hb levels between Group S and Group U (p = 0.264, p = 0.064 respectively). F-Hb and NSE were weakly correlated (r = 0.29. p < 0.01). In conclusion, NSE level immediately after cardiac surgery with CPB is modified by hemolysis rather than brain injury, therefore it would be unreliable as a biomarker of brain disorder.
Collapse
Affiliation(s)
- Nobuya Motoyoshi
- Department of Clinical Engineering, Asahikawa Medical University Hospital, Asahikawa, 078-8510, Japan
| | - Masahiro Tsutsui
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaokahigashi2, Asahikawa, Hokkaido, 078-8510, Japan.
| | - Kouji Soman
- Department of Clinical Engineering, Asahikawa Medical University Hospital, Asahikawa, 078-8510, Japan
| | - Tomonori Shirasaka
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaokahigashi2, Asahikawa, Hokkaido, 078-8510, Japan
| | - Takayuki Narita
- Department of Clinical Engineering, Asahikawa Medical University Hospital, Asahikawa, 078-8510, Japan
| | - Shingo Kunioka
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaokahigashi2, Asahikawa, Hokkaido, 078-8510, Japan
| | - Katsuyuki Naya
- Department of Clinical Engineering, Asahikawa Medical University Hospital, Asahikawa, 078-8510, Japan
| | - Daisuke Yamazaki
- Department of Clinical Engineering, Asahikawa Medical University Hospital, Asahikawa, 078-8510, Japan
| | - Masahiko Narita
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaokahigashi2, Asahikawa, Hokkaido, 078-8510, Japan
| | - Hiroyuki Kamiya
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaokahigashi2, Asahikawa, Hokkaido, 078-8510, Japan
| |
Collapse
|
3
|
Chaves Junior ADJ, Avelino PS, Lopes JB. Comparison of the Effects of Full Median Sternotomy vs. Mini-Incision on Postoperative Pain in Cardiac Surgery: A Meta-Analysis. Braz J Cardiovasc Surg 2024; 39:e20230154. [PMID: 38748974 PMCID: PMC11095119 DOI: 10.21470/1678-9741-2023-0154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 09/12/2023] [Indexed: 05/19/2024] Open
Abstract
INTRODUCTION It is not yet clear whether cardiac surgery by mini-incision (minimally invasive cardiac surgery [MICS]) is overall less painful than the conventional approach by full sternotomy (FS). A meta-analysis is necessary to investigate polled results on this topic. METHODS PubMed®/MEDLINE, Cochrane CENTRAL, Latin American and Caribbean Health Sciences Literature (or LILACS), and Scientific Electronic Library Online (or SciELO) were searched for all clinical trials, reported until 2022, comparing FS with MICS in coronary artery bypass grafting (CABG), mitral valve surgery (MVS), and aortic valve replacement (AVR), and postoperative pain outcome was analyzed. Main summary measures were the method of standardized mean differences (SMD) with a 95% confidence interval (CI) and P-values (considered statistically significant when < 0.05). RESULTS In AVR, the general estimate of postoperative pain effect favored MICS (SMD 0.87 [95% CI 0.04 to 1.71], P=0.04). However, in the sensitivity analysis, there was no difference between the groups (SMD 0.70 [95% CI -0.69 to 2.09], P=0.32). For MVS, it was not possible to perform a meta-analysis with the included studies, because they had different methodologies. In CABG, the general estimate of the effect of postoperative pain did not favor any of the approaches (SMD -0.40 [95% CI -1.07 to 0.26], P=0.23), which was confirmed by sensitivity analysis (SMD -0.02 [95% CI -0.71 to 0.67], P=0.95). CONCLUSION MICS was not globally less painful than the FS approach. It seems that postoperative pain is more related to the degree of tissue retraction than to the size of the incision.
Collapse
Affiliation(s)
| | | | - Jackson Brandão Lopes
- Department of Anesthesiology and Surgery, Faculdade de Medicina da
Bahia, Universidade Federal da Bahia (FMB/UFBA), Salvador, Bahia, Brazil
| |
Collapse
|
4
|
Portoghese M, Mureddu S, Balata A, Contini C, Carta G. Anomalous circumflex artery encircling the aortic annulus: implications for mitral valve repair. J Cardiothorac Surg 2024; 19:281. [PMID: 38715080 PMCID: PMC11075267 DOI: 10.1186/s13019-024-02779-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 04/27/2024] [Indexed: 05/12/2024] Open
Abstract
Injury to coronary arteries during mitral surgery is a rare but life-threatening procedural complication, an anomalous origin and course of the left circumflex artery (LCx) increase this risk. Recognizing the anomaly by the characteristic angiographic pattern and identifying its relationship with the surrounding anatomical structure using imaging techniques, mainly transesophageal echocardiography (TOE) or coronary computed tomography angiography (CCTA), is of crucial importance in setting up the best surgical strategy. We report a case of anomalous origin of a circumflex artery (LCx) from the proximal portion of the right coronary artery (RCA) with a pathway running retroaortically through the mitro-aortic space. An integrated diagnostic approach using a multidisciplinary team with a cardiologist and an imaging radiologist allowed us to decide the surgical strategy. We successfully performed a mitral valvular repair using a minimally invasive minithoracotomic approach and implanting a complete semirigid ring.
Collapse
Affiliation(s)
- Michele Portoghese
- Departement Of Cardiothoracic And Vascular Surgery, Cardiac Surgery Unit, A.O.U. Sassari, Sassari, Italy
| | - Simone Mureddu
- Departement Of Cardiothoracic And Vascular Surgery, Cardiac Surgery Unit, A.O.U. Sassari, Sassari, Italy
| | - Andrea Balata
- Departement Of Cardiothoracic And Vascular Surgery, Cardiac Anesthesiology Unit, A.O.U. Sassari, Sassari, Italy
| | - Cristina Contini
- Departement Of Cardiothoracic And Vascular Surgery, Cardiac Surgery Unit, A.O.U. Sassari, Sassari, Italy.
| | - Giangiacomo Carta
- Departement Of Cardiothoracic And Vascular Surgery, Cardiac Surgery Unit, A.O.U. Sassari, Sassari, Italy
| |
Collapse
|
5
|
Lee H, Kim J, Lee JH, Yoo JS. Minimally Invasive Approach versus Sternotomy for Cardiac Surgery in Jehovah's Witness Patients. J Cardiothorac Vasc Anesth 2024:S1053-0770(24)00295-7. [PMID: 38955617 DOI: 10.1053/j.jvca.2024.04.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 04/12/2024] [Accepted: 04/22/2024] [Indexed: 07/04/2024]
Abstract
OBJECTIVE To evaluate the outcomes of minimally invasive cardiac surgery (MICS) compared with the sternotomy approach for Jehovah's Witness (JW) patients who cannot receive blood transfusions DESIGN: This was a retrospective observational study. SETTING The study was conducted at a specialized cardiovascular intervention and surgery institute. PARTICIPANTS The study cohort comprised JW patients undergoing cardiac surgery between September 2016 and July 2022. INTERVENTIONS None MEASUREMENTS AND MAIN RESULTS: Patients (n = 63) were divided into MICS (n = 19) and sternotomy (n = 44) groups, and clinical outcomes were analyzed. There was no difference in types of operation except coronary bypass grafting (n = 1 [5.3%] in the MICS group v n = 20 [45.5%] in the sternotomy group; p = 0.005). There were no between-group differences in early mortality and morbidities. Overall survival did not differ significantly during the follow-up period (mean, 43.9 ± 24.4 months). The amount of chest tube drainage was significantly lower in the MICS group on the first postoperative day (mean, 224.0 ± 122.7 mL v 334.0 ± 187.0 mL in the sternotomy group; p = 0.022). The mean hemoglobin level was significantly higher in the MICS group on the day of operation (11.7 ± 1.3 mg/dL v 10.6 ± 2.0 mg/dL in the sternotomy group; p = 0.042) and the first postoperative day (12.3 ± 1.8 mg/dL v 11.2 ± 1.9 mg/dL; p = 0.032). CONCLUSIONS MICS for JW patients showed favorable early outcomes and mid-term survival compared to conventional sternotomy. MICS may be a viable option for JW patients who decline blood transfusions.
Collapse
Affiliation(s)
- Heemoon Lee
- Department of Thoracic and Cardiovascular Surgery, Bucheon Sejong Hospital, Bucheon, Gyeonggi-do, Republic of Korea
| | - Jihoon Kim
- Department of Thoracic and Cardiovascular Surgery, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Jong Hyun Lee
- Department of Anesthesiology and Pain Medicine, Bucheon Sejong Hospital, Bucheon, Gyeonggi-do, Republic of Korea
| | - Jae Suk Yoo
- Department of Thoracic and Cardiovascular Surgery, Bucheon Sejong Hospital, Bucheon, Gyeonggi-do, Republic of Korea.
| |
Collapse
|
6
|
Heuts S, Olsthoorn JR, Houterman S, Roefs MM, Maessen JG, Sardari Nia P. One-year postprocedural quality of life following mitral valve surgery: data from The Netherlands heart registration. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivae051. [PMID: 38521547 PMCID: PMC11021809 DOI: 10.1093/icvts/ivae051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 12/23/2023] [Accepted: 03/21/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVES The aim of surgical treatment of mitral valve disease is to reverse heart failure and to restore life expectancy and quality of life (QoL). In mitral valve surgery, QoL has not been studied extensively, especially regarding the surgical approach. The current study aimed to evaluate QoL after mitral valve surgery through full sternotomy and a minimally invasive approach (MIMVS). METHODS All patients undergoing mitral valve surgery between 2013-2018 through sternotomy or a MIMVS approach (right anterolateral mini-thoracotomy, sternal-sparing), with or without concomitant tricuspid valve surgery, surgical ablation, or atrial septal defect closure were eligible for inclusion in this multicentre nationwide registry in the Netherlands. Quality of life was measured using the 12- and 36-item short form surveys, before surgery and postoperatively at 1 year. Independent predictors for loss of QoL were evaluated. RESULTS 485 patients were included (full sternotomy: n = 276, and MIMVS: n = 209). Overall, patients experienced a significant increase in physical component score (56 [42-75] vs 74 [57-88], p < 0.001) and mental component score at 1-year (63 [52-74] vs 70 [59-86], p < 0.001). Baseline QoL scores and new onset of atrial arrhythmia were independently associated with a clinically relevant reduction in physical and mental QoL. CONCLUSIONS Mitral valve surgery is associated with significant improvement in physical and mental QoL. Baseline QoL scores and new onset of atrial arrhythmia are associated with a clinically relevant reduction in postoperative QoL.
Collapse
Affiliation(s)
- Samuel Heuts
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
| | - Jules R Olsthoorn
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, Netherlands
| | | | | | - Jos G Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
- Netherlands Heart Registration, Utrecht, Netherlands
| | - Peyman Sardari Nia
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
| |
Collapse
|
7
|
Papadopoulos N, Ntinopoulos V, Dushaj S, Häussler A, Odavic D, Biefer HRC, Dzemali O. Navigating the challenges of minimally invasive mitral valve surgery: a risk analysis and learning curve evaluation. J Cardiothorac Surg 2024; 19:24. [PMID: 38263168 PMCID: PMC10807125 DOI: 10.1186/s13019-024-02479-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 01/10/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND This study aimed to report the risk and learning curve analysis of a minimally invasive mitral valve surgery program performed through a right mini-thoracotomy at a single institution. METHODS From January 2013 through December 2019, 266 consecutive patients underwent minimally invasive mitral valve surgery in our department and were included in the current study. Multiple logistic regression analysis was used for the adverse event outcome. Distribution over time of perioperative complications, defined as clinical endpoints in the Valve Academic Research Consortium-2 (VARC-2) consensus document, as well as CUSUM charts for assessment of cardiopulmonary bypass and aortic cross-clamping duration over time, has been performed for learning curve assessment. RESULTS Overall incidences of postoperative stroke (1.1%), myocardial infarction (1.1%), and thirty-day mortality (1.5%) were low. The mitral valve reconstruction rate in our series was 95%. Multivariable analysis revealed that concomitant tricuspid valve surgery (OR 4.44; 95%CI 1.61-11.80; p = 0.003) was significantly associated with adverse event outcomes. Despite a trend towards adverse event outcomes in patients with preexisting active mitral valve endocarditis (OR 2.69; 95%CI 0.81-7.87; p = 0.082), mitral valve pathology did not significantly impact postoperative morbidity and mortality. Distribution over time of perioperative complications, defined as clinical endpoints in the VARC-2 consensus document, showed a trend towards an improved complication rate after the initial 65-100 procedures. CONCLUSIONS Mitral valve surgery via right-sided mini-thoracotomy can be implemented safely with low perioperative morbidity and mortality rates. Careful patient selection regarding isolated mitral valve surgery in the presence of degenerative mitral valve disease may represent a significant safety issue during the learning curve. TRIAL REGISTRATION The cantonal ethics commission of Zurich approved the study (registration ID 2020-00752, date of approval 24 April 2020).
Collapse
Affiliation(s)
- Nestoras Papadopoulos
- Department of Cardiac Surgery, City Hospital, Birmensdorferstrasse 497, 8063, Zurich, Switzerland.
- Department of Cardiac Surgery, University Hospital Zürich, Zurich, Switzerland.
| | - Vasileios Ntinopoulos
- Department of Cardiac Surgery, City Hospital, Birmensdorferstrasse 497, 8063, Zurich, Switzerland
- Department of Cardiac Surgery, University Hospital Zürich, Zurich, Switzerland
| | - Stak Dushaj
- Department of Cardiac Surgery, City Hospital, Birmensdorferstrasse 497, 8063, Zurich, Switzerland
- Department of Cardiac Surgery, University Hospital Zürich, Zurich, Switzerland
| | - Achim Häussler
- Department of Cardiac Surgery, City Hospital, Birmensdorferstrasse 497, 8063, Zurich, Switzerland
- Department of Cardiac Surgery, University Hospital Zürich, Zurich, Switzerland
| | - Dragan Odavic
- Department of Cardiac Surgery, City Hospital, Birmensdorferstrasse 497, 8063, Zurich, Switzerland
- Department of Cardiac Surgery, University Hospital Zürich, Zurich, Switzerland
| | - Hector Rodríguez Cetina Biefer
- Department of Cardiac Surgery, City Hospital, Birmensdorferstrasse 497, 8063, Zurich, Switzerland
- Department of Cardiac Surgery, University Hospital Zürich, Zurich, Switzerland
- Department of Cardiology, Center of Experimental and Translational Cardiology (CTEC), University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Omer Dzemali
- Department of Cardiac Surgery, City Hospital, Birmensdorferstrasse 497, 8063, Zurich, Switzerland
- Department of Cardiac Surgery, University Hospital Zürich, Zurich, Switzerland
- Department of Cardiology, Center of Experimental and Translational Cardiology (CTEC), University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| |
Collapse
|
8
|
Cocchieri R, Mousavi I, Verbeek EC, Riezebos RK, Yazdanbakhsh AP, de Mol BAMJ. Elderly patients benefit from minimally invasive mitral valve surgery: perioperative risk management matters. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivad211. [PMID: 38191999 PMCID: PMC10799754 DOI: 10.1093/icvts/ivad211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 08/28/2023] [Accepted: 01/10/2024] [Indexed: 01/10/2024]
Abstract
OBJECTIVES The goal was to assess the single-centre results of minimally invasive mitral valve surgery (MIMVS) in the elderly population. METHODS All patients referred for minimally invasive valve surgery underwent a standardized preoperative screening. We performed a retrospective analysis of 131 consecutive elderly patients (≥75 years) who underwent endoscopic MIMVS through a right mini-thoracotomy. Survival and postoperative course were assessed in 2 groups: a repair group and a replacement group. RESULTS Eighty-five patients underwent mitral valve repair, and 46 had mitral valve replacement. The mean age was 79 ± 2.9 years, and the median follow-up duration was 3.8 years. The cardiopulmonary bypass time (128.7 min vs 155.9 min, P = 0.012) and the cross-clamp time (84.9 min vs 124.1 min, P = 0.005) were significantly longer in the replacement group. Except for more reinterventions for bleeding in the replacement group (10.9% vs 0%, P = 0.005), there were no significant differences in the postoperative course between the 2 groups. Low mortality rates at the midterm follow-up were observed in both groups, and no differences were observed between the 4-and the 12-month follow-up. Survival rates after 1 year and 5 years were 97.6% and 88.6%, respectively, with no significant differences between the 2 groups. CONCLUSIONS MIMVS is an excellent treatment option in vulnerable elderly patients with excellent short- and long-term results. Although other studies suggest that repair could be superior to replacement even in older patients, our experience suggests that replacement is equivalent to repair in terms of mortality and major adverse cardiac and cerebrovascular events. Experience and standardized preoperative screening are mandatory to achieve optimal results.
Collapse
Affiliation(s)
| | - Iman Mousavi
- Department of Cardiothoracic Surgery, OLVG, Amsterdam, the Netherlands
| | - Eva C Verbeek
- Department of Cardiothoracic Surgery, OLVG, Amsterdam, the Netherlands
| | | | | | - Bas A M J de Mol
- Department of Cardiothoracic Surgery, AUMC, Amsterdam, the Netherlands
| |
Collapse
|
9
|
Ilcheva L, Risteski P, Tudorache I, Häussler A, Papadopoulos N, Odavic D, Rodriguez Cetina Biefer H, Dzemali O. Beyond Conventional Operations: Embracing the Era of Contemporary Minimally Invasive Cardiac Surgery. J Clin Med 2023; 12:7210. [PMID: 38068262 PMCID: PMC10707549 DOI: 10.3390/jcm12237210] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/18/2023] [Accepted: 11/18/2023] [Indexed: 06/26/2024] Open
Abstract
Over the past two decades, minimally invasive cardiac surgery (MICS) has gained a significant place due to the emergence of innovative tools and improvements in surgical techniques, offering comparable efficacy and safety to traditional surgical methods. This review provides an overview of the history of MICS, its current state, and its prospects and highlights its advantages and limitations. Additionally, we highlight the growing trends and potential pathways for the expansion of MICS, underscoring the crucial role of technological advancements in shaping the future of this field. Recognizing the challenges, we strive to pave the way for further breakthroughs in minimally invasive cardiac procedures.
Collapse
Affiliation(s)
- Lilly Ilcheva
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
| | - Petar Risteski
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
| | - Igor Tudorache
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
| | - Achim Häussler
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
| | - Nestoras Papadopoulos
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
| | - Dragan Odavic
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
| | - Hector Rodriguez Cetina Biefer
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
| | - Omer Dzemali
- Department of Cardiac Surgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.I.); (P.R.); (I.T.); (A.H.); (N.P.); (D.O.); (H.R.C.B.)
- Department of Cardiac Surgery, Zurich City Hospital—Triemli, 8055 Zurich, Switzerland
| |
Collapse
|
10
|
Aston D, Zeloof D, Falter F. Anaesthesia for Minimally Invasive Cardiac Surgery. J Cardiovasc Dev Dis 2023; 10:462. [PMID: 37998520 PMCID: PMC10672390 DOI: 10.3390/jcdd10110462] [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: 10/15/2023] [Revised: 11/04/2023] [Accepted: 11/13/2023] [Indexed: 11/25/2023] Open
Abstract
Minimally invasive cardiac surgery (MICS) has been used since the 1990s and encompasses a wide range of techniques that lack full sternotomy, including valve and coronary artery graft surgery as well as transcatheter procedures. Due to the potential benefits offered to patients by MICS, these procedures are becoming more common. Unique anaesthetic knowledge and skills are required to overcome the specific challenges presented by MICS, including mastery of transoesophageal echocardiography (TOE) and the provision of thoracic regional analgesia. This review evaluates the relevance of MICS to the anaesthetist and discusses pre-operative assessment, the relevant adjustments to intra-operative conduct that are necessary for these techniques, as well as post-operative care and what is known about outcomes.
Collapse
Affiliation(s)
- Daniel Aston
- Department of Anaesthesia and Critical Care, Royal Papworth NHS Foundation Trust, Cambridge Biomedical Campus, Papworth Road, Cambridge CB2 0AY, UK; (D.Z.); (F.F.)
| | | | | |
Collapse
|
11
|
Yates TA, McGilvray M, Vinyard C, Sinn L, Razo N, He J, Roberts HG, Schill MR, Zemlin C, Damiano RJ. Minimally Invasive Mitral Valve Surgery With Concomitant Cox Maze Procedure Is as Effective as a Median Sternotomy With Decreased Morbidity. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2023; 18:565-573. [PMID: 38013234 DOI: 10.1177/15569845231209974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
OBJECTIVE A right minithoracotomy (RMT) is a minimally invasive surgical approach that has been increasingly performed for the concomitant Cox maze IV procedure (CMP) and mitral valve surgery (MVS). Little is known regarding whether long-term rhythm and survival outcomes are affected by the RMT as compared with the traditional median sternotomy (MS) approach. METHODS Between April 2004 and April 2021, 377 patients underwent the concomitant CMP and MVS, of whom 38% had RMT. Propensity score matching yielded 116 pairs. Freedom from atrial tachyarrhythmias (ATA) was assessed with prolonged monitoring annually for 8 years. Survival, rhythm, and perioperative outcomes were compared. RESULTS The unmatched RMT cohort had a greater freedom from ATA recurrence at 1 year (99% vs 90%, P = 0.001) and 3 years (94% vs 86%, P = 0.045). The matched RMT cohort had longer cardiopulmonary bypass (median: 215 [199 to 253] vs 170 [136 to 198] min, P < 0.001) and aortic cross-clamp (110 [98 to 124] vs 86 [71 to 102] min, P < 0.001) times but shorter intensive care time (48 [24 to 95] vs 71 [26 to 144] h, P = 0.001) and length of stay (8 [6 to 11] vs 10 [7 to 14] h, P < 0.001). More pacemakers (18% vs 4%, P < 0.001) and postoperative transfusions (57% vs 41%, P = 0.014) occurred in the MS cohort. The 30-day mortality (P = 0.651) and 8-year survival (P = 0.072) was not significantly different between the cohorts. CONCLUSIONS Early 1-year and 3-year freedom from ATA recurrence was better in the RMT cohort compared with the MS cohort. Despite longer operative times, the RMT cohort had shorter lengths of stay, fewer postoperative transfusions, and fewer pacemakers placed.
Collapse
Affiliation(s)
- Tari-Ann Yates
- Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, Saint Louis, MO, USA
| | - Martha McGilvray
- Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, Saint Louis, MO, USA
| | - Connor Vinyard
- Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, Saint Louis, MO, USA
| | - Laurie Sinn
- Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, Saint Louis, MO, USA
| | - Nicholas Razo
- Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, Saint Louis, MO, USA
| | - June He
- Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, Saint Louis, MO, USA
| | - Harold G Roberts
- Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, Saint Louis, MO, USA
| | - Matthew R Schill
- Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, Saint Louis, MO, USA
| | - Christian Zemlin
- Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, Saint Louis, MO, USA
| | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, Saint Louis, MO, USA
| |
Collapse
|
12
|
Kim WK, Rhee Y, Bae S. Muscle-sparing minithoractomy for cardiac surgery: Surgical technique. JTCVS Tech 2023; 21:86-91. [PMID: 37854837 PMCID: PMC10580171 DOI: 10.1016/j.xjtc.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/02/2023] [Accepted: 08/07/2023] [Indexed: 10/20/2023] Open
Affiliation(s)
- Wan Kee Kim
- Department of Thoracic and Cardiovascular Surgery, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Younju Rhee
- Department of Thoracic and Cardiovascular Surgery, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - SungA Bae
- Department of Cardiology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si, Gyeonggi-do, Republic of Korea
| |
Collapse
|
13
|
Kruse J, Silaschi M, Velten M, Wittmann M, Alaj E, Ahmad AES, Zimmer S, Borger MA, Bakhtiary F. Femoral or Axillary Cannulation for Extracorporeal Circulation during Minimally Invasive Heart Valve Surgery (FAMI): Protocol for a Multi-Center Prospective Randomized Trial. J Clin Med 2023; 12:5344. [PMID: 37629384 PMCID: PMC10455070 DOI: 10.3390/jcm12165344] [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: 06/22/2023] [Revised: 07/29/2023] [Accepted: 07/30/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Minimally invasive heart valve surgery via anterolateral mini-thoracotomy with full endoscopic 3D visualization (MIS) has become the standard treatment of patients with valvular heart disease and low operative risk over the past two decades. It requires extracorporeal circulation and cardioplegic arrest. The most established form of arterial cannulation for MIS is through the femoral artery and is used by most surgeons, but it is suspected to increase the risk of stroke through retrograde blood flow. An alternative route of cannulation is the axillary artery, producing antegrade blood flow during extracorporeal circulation. METHODS Femoral or axillary cannulation for extracorporeal circulation during minimally invasive heart valve surgery (FAMI) is a multicenter randomized controlled trial designed to determine whether axillary cannulation is superior to femoral cannulation for the outcome of a manifest stroke within 7 days postoperatively. The target sample size was 848 participants. Patients ≥ 18 years of age, with valvular regurgitation or stenosis scheduled for minimally invasive surgery via anterolateral mini-thoracotomy, were randomized to axillary cannulation (treatment group) or to femoral cannulation (standard care). Patients were followed up for seven days postoperatively. A CT scan was performed pre-operatively to screen patients for vascular calcifications and to assess the safety of femoral cannulation. The standard of care is femoral artery cannulation, but is performed only in patients without significant vascular calcifications or severe kinking of the iliac arteries and in patients with sufficient vessel diameter. The cannulation is performed via Seldinger's technique, and the vessel closed percutaneously using a plug-based vascular closure device. Only patients without significant vascular calcifications are considered for femoral cannulation, as an increased risk of stroke is assumed. In patients with vascular calcifications, axillary cannulation is the standard of care to avoid these risks. Retrospective studies have hinted that, even in patients without vascular calcifications, there may be a lower stroke risk with axillary cannulation compared to femoral cannulation. We present a protocol for a multi-center randomized trial to investigate this hypothesis. DISCUSSION To date, evidence on the best access for peripheral artery cannulation during minimally invasive heart valve surgery has been scarce. Patients may benefit from axillary cannulation for extracorporeal circulation in terms of stroke risk and other neurological and vascular complications, though femoral cannulation is the gold standard. The aim of this study is to determine the risks of peri-operative stroke in a prospective randomized comparison of femoral vs. axillary cannulation.
Collapse
Affiliation(s)
- Jacqueline Kruse
- Department of Cardiac Surgery, University Hospital Bonn, 53127 Bonn, Germany; (M.S.)
| | - Miriam Silaschi
- Department of Cardiac Surgery, University Hospital Bonn, 53127 Bonn, Germany; (M.S.)
| | - Markus Velten
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, 53127 Bonn, Germany
| | - Maria Wittmann
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, 53127 Bonn, Germany
| | - Eissa Alaj
- Department of Cardiac Surgery, University Hospital Bonn, 53127 Bonn, Germany; (M.S.)
| | - Ali El-Sayed Ahmad
- Department of Cardiac Surgery, University Hospital Bonn, 53127 Bonn, Germany; (M.S.)
| | - Sebastian Zimmer
- Department of Cardiology, University Hospital Bonn, 53127 Bonn, Germany
| | - Michael A. Borger
- Department of Cardiac Surgery, Leipzig Heart Center, 04289 Leipzig, Germany
| | - Farhad Bakhtiary
- Department of Cardiac Surgery, University Hospital Bonn, 53127 Bonn, Germany; (M.S.)
| |
Collapse
|
14
|
Massey J, Soppa G, Shanmuganathan S, Palmer K, Modi P. Why are we even still discussing this? The evidence is clear and should be reflected in international guidelines. Eur J Cardiothorac Surg 2023; 64:ezad278. [PMID: 37561098 DOI: 10.1093/ejcts/ezad278] [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] [Received: 07/23/2023] [Accepted: 08/09/2023] [Indexed: 08/11/2023] Open
Affiliation(s)
- John Massey
- The Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Gopal Soppa
- The Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | | | - Kenneth Palmer
- The Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Paul Modi
- The Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| |
Collapse
|
15
|
Van Praet KM, Kofler M, Wilkens K, Sündermann SH, Meyer A, Hommel M, Jacobs S, Falk V, Kempfert J. Minimally Invasive Extirpation of Benign Atrial Cardiac Tumors: Clinical Follow-Up and Survival. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2023:15569845231170000. [PMID: 37144727 DOI: 10.1177/15569845231170000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVE Evidence determining the optimal treatment for cardiac tumors is rare. We report our midterm clinical outcome and patient characteristics of our series undergoing atrial tumor removal through a right lateral minithoracotomy (RLMT). METHODS From 2015 to 2021, 51 patients underwent RLMT for atrial tumor extirpation. Patients receiving concomitant atrioventricular valvular, cryoablation, and/or patent foramen ovale closure surgery were included. Follow-up was performed using standardized questionnaires (mean: 1,041 ± 666 days). Follow-up involved any tumor recurrence, clinical symptoms, and any recurrent arterial embolization. Survival analysis was successfully achieved in all patients. RESULTS Successful surgical resection was achieved in all patients. Mean cardiopulmonary bypass and cross-clamping times were 75 ± 36 and 41 ± 22 min, respectively. The most common tumor location was the left atrium (n = 42, 82.4%). Mean ventilation time was 12.74 ± 17.23 h, intensive care unit stay ranged from 1 to 1.9 days (median: 1 day). Nineteen patients (37.3%) received concomitant surgery. Histopathological analysis showed 38 myxoma (74.5%), 9 papillary fibroelastoma (17.6%), and 4 thrombus (7.8%). Thirty-day mortality was observed in 1 case (2%). One patient (2%) suffered a stroke postoperatively. No patient had a relapse of cardiac tumor. Three patients (9.7%) showed arterial embolization during follow-up. Thirteen follow-up patients (25.5%) were in New York Heart Association class ≤II. Overall survival was 90.2% at 2 years. CONCLUSIONS A minimally invasive approach for benign atrial tumor resection is effective, safe, and reproducible. Of the atrial tumors, 74.5% were myxoma and 82% were located in the left atrium. A low 30-day mortality rate with no manifestation of recurrent intracardiac tumor was observed.
Collapse
Affiliation(s)
- Karel M Van Praet
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany
- DZHK (German Center of Cardiovascular Research), Partner Site Berlin, Germany
| | - Markus Kofler
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany
- DZHK (German Center of Cardiovascular Research), Partner Site Berlin, Germany
| | - Kristin Wilkens
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany
| | - Simon H Sündermann
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany
- DZHK (German Center of Cardiovascular Research), Partner Site Berlin, Germany
| | - Alexander Meyer
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany
- DZHK (German Center of Cardiovascular Research), Partner Site Berlin, Germany
| | - Matthias Hommel
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany
- Department of Cardiac Anesthesiology and Intensive Care Medicine, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
| | - Stephan Jacobs
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany
- DZHK (German Center of Cardiovascular Research), Partner Site Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany
- DZHK (German Center of Cardiovascular Research), Partner Site Berlin, Germany
- Translational Cardiovascular Technologies, Institute of Translational Medicine, Department of Health Sciences and Technology, Swiss Federal Institute of Technology (ETH), Zurich, Switzerland
| | - Jörg Kempfert
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany
- DZHK (German Center of Cardiovascular Research), Partner Site Berlin, Germany
| |
Collapse
|
16
|
Al Shamry A, Jegaden M, Ashafy S, Eker A, Jegaden O. Minithoracotomy versus sternotomy in mitral valve surgery: meta-analysis from recent matched and randomized studies. J Cardiothorac Surg 2023; 18:101. [PMID: 37024952 PMCID: PMC10080824 DOI: 10.1186/s13019-023-02229-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 04/02/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND There is still ongoing debate about the benefits of mini-thoracotomy (MTH) approach in mitral valve surgery in comparison with complete sternotomy (STER). This study aims to update the current evidence with mortality as primary end point. METHODS The MEDLINE and EMBASE databases were searched through June 2022. Two randomized studies and 16 propensity score matched studies published from 2011 to 2022 were included with a total of 12,997 patients operated on from 2005 (MTH: 6467, STER: 6530). Data regarding early mortality, stroke, reoperation for bleeding, new renal failure, new onset of atrial fibrillation, need of blood transfusion, prolonged ventilation, wound infection, time-related outcomes (cross clamp time, cardiopulmonary bypass time, ventilation time, length of intensive care unit stay, length of hospital stay), midterm mortality and reoperation, and costs were extracted and submitted to a meta-analysis using weighted random effects modeling. RESULTS The incidence of early mortality, stroke, reoperation for bleeding and prolonged ventilation were similar, all in the absence of heterogeneity. However, the sub-group analysis showed a significant OR in favor of MTH when robotic enhancement was used. New renal failure (OR 1.67, 95% CI 1.06-2.62, p = 0.03), new onset of atrial fibrillation (OR 1.31, 95% CI 1.15-1.51, p = 0.001) and the need of blood transfusion (OR 1.77, 95% CI 1.39-2.27, p = 0.001) were significantly lower in MTH group. Regarding time-related outcomes, there was evidence for important heterogeneity of treatment effect among the studies. Operative times were longer in MTH: differences in means were 20.7 min for cross clamp time (95% CI 14.9-26.4, p = 0.001), 36.8 min for CPB time (95% CI 29.8-43.9, p = 0.001) and 37.7 min for total operative time (95% CI 19.6-55.8, p < 0.001). There was no significant difference in ventilation duration; however, the differences in means showed significantly shorter ICU stay and hospital stay after MTH compared to STER: - 0.6 days (95% CI - 1.1/- 0.21, p = 0.001) and - 1.88 days (95% CI - 2.72/- 1.05, p = 0.001) respectively, leading to a significant lower hospital cost after MTH compared to STER with difference in means - 4528 US$ (95% CI - 8725/- 326, p = 0.03). The mid-term mortality was significantly higher after STER compared to MTH: OR = 1.50, 1.09-2.308 (95% CI), p = 0.01; the rate of mid-term reoperation was reported similar in MTH and STER: OR = 0.76, 0.50-1.15 (95% CI), p = 0.19. CONCLUSIONS The present meta-analysis confirms that the MTH approach for mitral valve disease remains associated with prolonged operative times, but it is beneficial in terms of reduced postoperative complications (renal failure, atrial fibrillation, blood transfusion, wound infection), length of stay in ICU and in hospitalization, with finally a reduction in global cost. MTH approach appears associated with a significant reduction of postoperative mortality that must be confirmed by large randomized study.
Collapse
Affiliation(s)
- Adel Al Shamry
- Department of Cardiac Surgery and ICU, Saudi German Hospital, Dubai, UAE
| | - Margaux Jegaden
- Department of Surgery, Kremlim Bicetre Hospital, Paris, France
| | - Salah Ashafy
- Department of Cardiac Surgery, Zayed Military Hospital, Abu Dhabi, UAE
| | - Armand Eker
- Department of Cardiac Surgery, Centre Cardio-Thoracic, Monaco, Monaco
| | - Olivier Jegaden
- Department of Cardiac Surgery, Mediclinic Middle East, Mediclinic Airport Road Hospital, MBRU, PO Box 48481, Abu Dhabi, UAE.
| |
Collapse
|
17
|
Minimal Access Tricuspid Valve Surgery. J Cardiovasc Dev Dis 2023; 10:jcdd10030118. [PMID: 36975882 PMCID: PMC10051570 DOI: 10.3390/jcdd10030118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/08/2023] [Accepted: 03/10/2023] [Indexed: 03/16/2023] Open
Abstract
Tricuspid valve diseases are a heterogeneous group of pathologies that typically have poor prognoses when treated medically and are associated with significant morbidity and mortality with traditional surgical techniques. Minimal access tricuspid valve surgery may mitigate some of the surgical risks associated with the standard sternotomy approach by limiting pain, reducing blood loss, lowering the risk of wound infections, and shortening hospital stays. In certain patient populations, this may allow for a prompt intervention that could limit the pathologic effects of these diseases. Herein, we review the literature on minimal access tricuspid valve surgery focusing on perioperative planning, technique, and outcomes of minimal access endoscopic and robotic surgery for isolated tricuspid valve disease.
Collapse
|
18
|
Mastro F, Angelini A, D'Onofrio A, Gerosa G. A journey from resect to respect to restore: aiming at optimal physiological surgical mitral valve repair. J Cardiovasc Med (Hagerstown) 2023; 24:1-11. [PMID: 36484280 DOI: 10.2459/jcm.0000000000001390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The concept of 'repairing' a degenerated mitral valve in order to restore the native competence means achieving the best physiological result coupled with the least invasive approach: this represents an interesting challenge for cardiac surgeons. The evolution of cardiac surgery through the years has involved techniques and technologies in every field of interest. From 'resect', to 'respect', to 'restore': the micro-invasive approach based on Neochord implant implies a transapical beating heart surgery which is based on the concept of implanting artificial chordae, preserving the physiological dynamics of the mitral annulus and avoiding the disadvantages of cardiopulmonary bypass and cardioplegic arrest of the heart.
Collapse
Affiliation(s)
- Florinda Mastro
- Cardiac Surgery Unit, Cardio-Thoracic-Vascular Sciences and Public Health Department, Padova University Hospital, Padova
| | - Annalisa Angelini
- Cardiovascular Pathology, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Augusto D'Onofrio
- Cardiac Surgery Unit, Cardio-Thoracic-Vascular Sciences and Public Health Department, Padova University Hospital, Padova
| | - Gino Gerosa
- Cardiac Surgery Unit, Cardio-Thoracic-Vascular Sciences and Public Health Department, Padova University Hospital, Padova
| |
Collapse
|
19
|
Safety and Efficacy of the Transaxillary Access for Minimally Invasive Mitral Valve Surgery-A Propensity Matched Competitive Analysis. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121850. [PMID: 36557053 PMCID: PMC9785245 DOI: 10.3390/medicina58121850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/08/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
Background and Objectives: Transaxillary access is a straightforward “single incision—direct vision” concept, based on a 5 cm skin incision in the right anterior axillary line. It is suitable for aortic, mitral and tricuspid surgery. The present study evaluates the hospital outcomes of the transaxillary access for isolated mitral valve surgery compared with full sternotomy. Patients and Methods: The final study group included 480 patients. A total of 160 consecutive transaxillary patients served as treatment group (MICS-MITRAL). Based on a multivariate logistic regression model including age, sex, body-mass-index, EuroScore II and LVEF, a 1:2 propensity matched control-group (n = 320) was generated out of 980 consecutive sternotomy patients. Redo surgeries, endocarditis or combined procedures were excluded. The mean age was 66.6 ± 10.6 years, 48.6% (n = 234) were female. EuroSCORE II averaged 1.98 ± 1.4%. Results: MICS-MITRAL had longer perfusion (88.7 ± 26.6 min vs. 68.7 ± 32.7 min; p < 0.01) and cross-clamp (64.4 ± 22.3 min vs. 49.7 ± 22.4 min; p < 0.01) times. This did not translate into longer procedure times (132 ± 31 min vs. 131 ± 46 min; p = 0.76). Both groups showed low rates of failed repair (MICS-MITRAL: n = 6/160; 3.75%; Sternotomy: n = 10/320; 3.1%; p = 0.31). MICS-MITRAL had lower transfusion rates (p ≤ 0.001), less re-exploration for bleeding (p = 0.04), shorter ventilation times (p = 0.02), shorter ICU-stay (p = 0.05), less postoperative hemofiltration (p < 0.01) compared to sternotomy patients. No difference was seen in the incidence of stroke (p = 0.47) and postoperative delirium (p = 0.89). Hospital mortality was significantly lower in MICS-MITRAL patients (0.0% vs. 3.4%; p = 0.02). Conclusions: The transaxillary access for MICS-MITRAL provides superior cosmetics and excellent clinical outcomes. It can be performed at least as safely and in the same time frame as conventional mitral surgery by sternotomy.
Collapse
|
20
|
Hashim SW, McMahon SR, Vaitkeviciute IK, Collazo S, Hashim IM, Loya DS, Takata ET, Mather JF, McKay RG. Propensity-matched comparison of right mini-thoracotomy versus median sternotomy for isolated mitral valve repair. THE JOURNAL OF CARDIOVASCULAR SURGERY 2022; 63:724-733. [PMID: 36106398 DOI: 10.23736/s0021-9509.22.12397-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND A right mini-thoracotomy (RT) versus median sternotomy (MS) approach for isolated mitral valve (MV) repair has been associated with less postoperative morbidity, shorter hospital stay, and faster functional recovery, but with consistently longer cross-clamp time and higher operative costs. METHODS We assessed the impact of a modified operative technique on outcomes in 158 RT versus 129 MS patients treated with myxomatous MV repair from 2016 through 2021. Propensity matching based upon the Society of Thoracic Surgeons Risk Score was used to compare 108 patients in each cohort. RESULTS Propensity-matched RT patients had reductions in total ventilation time (P=0.025), postoperative atrial fibrillation (P=0.019), and hospital length of stay (P<0.001). RT and MS patients had similar cross-clamp times (66.4±13.7 vs 64.8±16.0 minutes, P=0.414), with less overall leaflet resection (32.4% vs 57.4%, P<0.001) and fewer Gore-Tex NeoChords implanted per patient (1.7±0.7 vs 2.1±1.0, P=0.028) in the RT group. The two cohorts did not differ with respect to 30-day major surgical complications. No patient died and there was no difference between the two groups with respect to freedom from re-operation (98.2% vs 98.2%, P=0.800) at a mean follow-up of 21.4±18.5 months. Direct total hospital costs were lower for the RT group (P=0.018), with reductions in postoperative charges offsetting increased operating room costs. CONCLUSIONS In this single-center study, the RT compared to the MS approach for myxomatous MV repair resulted in less postoperative morbidity and shorter hospital length of stay, with similar cross-clamp time, reduced total hospital costs, and comparable intermediate outcomes.
Collapse
Affiliation(s)
- Sabet W Hashim
- Hartford Health Care Heart and Vascular Institute, Hartford Hospital, Hartford, CT, USA
| | - Sean R McMahon
- Hartford Health Care Heart and Vascular Institute, Hartford Hospital, Hartford, CT, USA
| | - Irena K Vaitkeviciute
- Hartford Health Care Heart and Vascular Institute, Hartford Hospital, Hartford, CT, USA
| | - Susan Collazo
- Hartford Health Care Heart and Vascular Institute, Hartford Hospital, Hartford, CT, USA
| | | | - Deborah S Loya
- Hartford Health Care Heart and Vascular Institute, Hartford Hospital, Hartford, CT, USA
| | - Edmund T Takata
- Integrated Anesthesia Associates, Hartford Hospital, Hartford, CT, USA -
| | - Jeff F Mather
- Research Administration, Hartford Hospital, Hartford, CT, USA
| | - Raymond G McKay
- Hartford Health Care Heart and Vascular Institute, Hartford Hospital, Hartford, CT, USA
| |
Collapse
|
21
|
Olsthoorn JR, Heuts S, Houterman S, Roefs M, Maessen JG, Nia PS. Does concomitant tricuspid valve surgery increase the risks of minimally invasive mitral valve surgery? A multicentre comparison based on data from The Netherlands Heart Registration. J Card Surg 2022; 37:4362-4370. [PMID: 36229944 PMCID: PMC10091696 DOI: 10.1111/jocs.17004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/29/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Mitral valve (MV) disease is often accompanied by tricuspid valve (TV) disease. The indication for concomitant TV surgery during primary MV surgery is expected to increase, especially through a minimally invasive surgical (MIS) approach. The aim of the current study is to investigate the safety of the addition of TV surgery to MV surgery in MIMVS in a nationwide registry. METHODS Patients undergoing atrioventricular valve surgery through sternotomy or MIS between 2013 and 2018 were included. Patients undergoing MV surgery only through sternotomy or MIS were used as comparison. Primary outcomes were short-term morbidity and mortality and long-term survival. Propensity score matching was used to correct for potential confounders. RESULTS The whole cohort consisted of 2698 patients. A total of 558 patients had atrioventricular double valve surgery through sternotomy and 86 through MIS. As a comparison, 1365 patients underwent MV surgery through sternotomy and 689 patients through MIS. No differences in 30- and 120-day mortality were observed between the groups, both unmatched and matched. 5-year survival did not differ for double atrioventricular valve surgery through either sternotomy or MIS in the matched population (90.1% vs. 95.3%, Log-Rank p = .12). A higher incidence of re-exploration for bleeding (n = 12 [15.2%] vs. n = 3 [3.8%], p = .02) and new onset arrhythmia (n = 35 [44.3%] vs. n = 13 [16.5%], p < .001) was observed in double valve surgery through MIS. Median length of hospital stay (LOHS) was longer in the minimally invasive double valve group (9 days [6-13]) compared with sternotomy (7 days [6-11]; p = .04). CONCLUSION No differences in short-term mortality and 5-year survival were observed when tricuspid valve was added to MV surgery in MIS or sternotomy. The addition of tricuspid valve surgery is associated with higher incidence of re-exploration for bleeding, new onset arrhythmia. A longer LOHS was observed for MIS compared to sternotomy.
Collapse
Affiliation(s)
- Jules R Olsthoorn
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Samuel Heuts
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Maaike Roefs
- Netherlands Heart Registration, Utrecht, The Netherlands
| | - Jos G Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Peyman S Nia
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | | |
Collapse
|
22
|
Rao A, Tauber K, Szeto WY, Hargrove WC, Atluri P, Acker M, Crawford T, Ibrahim ME. Robotic and endoscopic mitral valve repair for degenerative disease. Ann Cardiothorac Surg 2022; 11:614-621. [PMID: 36483610 PMCID: PMC9723529 DOI: 10.21037/acs-2022-rmvs-28] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 11/18/2022] [Indexed: 04/08/2024]
Abstract
BACKGROUND Minimally invasive mitral valve repair has been proven to be a safe alternative to open sternotomy and may be accomplished through classic endoscopic and robotic endoscopic approaches. Outcomes across different minimally invasive techniques have been insufficiently described. We compare early and late clinical outcomes across matched patients undergoing robotic endoscopic and classic endoscopic repair. METHODS From 2011 to 2020, 786 patients underwent minimally invasive mitral surgery, from which we were able to generate 124 matched patients (62 patients in each cohort). Clinical results were then compared between the two matched populations. Survival analysis was used to compare freedom from mortality to 10 years among matched classic endoscopic and robotic endoscopic mitral valve repair cohorts and to calculate freedom from moderate or severe mitral insufficiency at latest follow-up. Histograms of cardiopulmonary bypass (CPB) and aortic cross-clamp times were constructed, and mean bypass and cross-clamp times were compared between classic endoscopic and robotic endoscopic cohorts. RESULTS There was no difference in early or late mortality at 10 years in either cohort. Freedom from moderate or severe mitral regurgitation or mitral valve replacement at last echocardiogram was 86.4% vs. 73.5% at 10 years, P=0.97. Patients undergoing robotic endoscopic mitral repair had a significantly longer CPB run when compared to the classic endoscopic cohort, with 148 min of CPB in the robotic endoscopic cohort compared to 133 min in the classic endoscopic group, P=0.03. Overall post-operative length of stay was not statistically significant between the robotic endoscopic and classic endoscopic groups, 6.3±0.5 and 6.0±0.3 days, respectively. No patients in either cohort developed renal failure or wound infection. The classic endoscopic group had a slightly higher risk of prolonged ventilation when compared to the robotic endoscopic group, with three classic endoscopic patients remaining intubated >8 hours post-operatively, compared to a single patient in the robotic endoscopic group. There were no unplanned reoperations in either group. Rates of postoperative stroke were comparable between groups (three in the classic endoscopic cohort, and two in the robotic endoscopic cohort). CONCLUSIONS Index mitral valve surgery via a classic endoscopic approach yields similar clinical outcomes when compared to robotic endoscopic surgery. We demonstrate that both classic endoscopic and robotic endoscopic approaches allow repair of degenerative mitral valves with excellent short- and medium-term outcomes in a tertiary referral center.
Collapse
Affiliation(s)
- Akhil Rao
- University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Karissa Tauber
- University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Wilson Y Szeto
- University of Pennsylvania Health System, Philadelphia, PA, USA
| | | | - Pavan Atluri
- University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Michael Acker
- University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Todd Crawford
- University of Pennsylvania Health System, Philadelphia, PA, USA
| | | |
Collapse
|
23
|
Sanetra K, Buszman PP, Jankowska-Sanetra J, Cisowski M, Fil W, Gorycki B, Bochenek A, Slabon-Turska M, Konopko M, Kaźmierczak P, Gerber W, Milewski K, Buszman PE. One-stage hybrid coronary revascularization for the treatment of multivessel coronary artery disease— Periprocedural and long-term results from the “HYBRID-COR” feasibility study. Front Cardiovasc Med 2022; 9:1016255. [PMID: 36337903 PMCID: PMC9626513 DOI: 10.3389/fcvm.2022.1016255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 09/26/2022] [Indexed: 11/18/2022] Open
Abstract
Background The constant growth of interest in hybrid coronary artery revascularization (HCR) is apparent. Yet, few studies report outcomes of the one-stage HCR. Consequently, the status of such procedures is not adequately supported in clinical guidelines. The aim of this study was to report the safety, feasibility, and long term-outcomes of the one-stage HCR. Methods and results Patients were enrolled in the prospective one-stage hybrid coronary revascularization program (HYBRID-COR). They underwent a one-stage hybrid revascularization procedure while on double antiplatelet therapy (DAPT) with Ticagrelor: endoscopic atraumatic coronary artery bypass grafting (EACAB) for revascularization of the left anterior descending (LAD) artery and percutaneous intervention in non-LAD arteries with contemporary drug-eluting stents. The composite primary endpoint included MACCE (major adverse cardiac and cerebrovascular events: death, myocardial infarction, stroke, and repeated revascularization) in long-term observation. The study cohort consisted of 30 patients (68% male) with stable coronary artery disease (26.7%) and unstable angina (73.3%). Procedural success was 100%. No death, myocardial infarction (MI), or stroke were observed in the perioperative period. One patient (3.3%) required chest revision and blood transfusion due to surgical bleeding. Kidney injury was noted in two patients (6.6%). In a long-term follow-up (median; IQR: 4.25; 2.62–4.69 years), two patients (6.6%) underwent repeated revascularization and one patient (3.3%) died due to MI. The overall primary endpoint rate was 9.9%. Conclusion One-stage hybrid revascularization, on DAPT, is a feasible, safe, and efficient way of achieving complete revascularization in selected patients. The complication rate is low and acceptable. Further randomized trials are required.
Collapse
Affiliation(s)
- Krzysztof Sanetra
- Clinic of Cardiovascular Surgery, Andrzej Frycz Modrzewski Krakow University, Kraków, Poland
- Department of Cardiac Surgery, American Heart of Poland, Bielsko-Biała, Poland
| | - Piotr Paweł Buszman
- Department of Cardiology, Andrzej Frycz Modrzewski Krakow University, Kraków, Poland
- Department of Cardiology, American Heart of Poland, Bielsko-Biała, Poland
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland
- *Correspondence: Piotr Paweł Buszman,
| | | | - Marek Cisowski
- Department of Cardiac Surgery, University Hospital, Institute of Medical Sciences, University of Opole, Opole, Poland
| | - Wojciech Fil
- Department of Cardiology, Andrzej Frycz Modrzewski Krakow University, Kraków, Poland
- Department of Cardiology, American Heart of Poland, Bielsko-Biała, Poland
| | - Bogdan Gorycki
- Department of Cardiology, American Heart of Poland, Bielsko-Biała, Poland
| | - Andrzej Bochenek
- Department of Cardiac Surgery, American Heart of Poland, Bielsko-Biała, Poland
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland
- Faculty of Medicine, University of Technology, Katowice, Poland
| | - Monika Slabon-Turska
- Department of Obstetrics and Gynecology, Provincial Specialist Hospital, Wrocław, Poland
| | - Marta Konopko
- Department of Cardiology, Andrzej Frycz Modrzewski Krakow University, Kraków, Poland
| | | | - Witold Gerber
- Department of Cardiac Surgery, American Heart of Poland, Bielsko-Biała, Poland
- Faculty of Medicine, University of Technology, Katowice, Poland
| | - Krzysztof Milewski
- Department of Cardiology, American Heart of Poland, Bielsko-Biała, Poland
- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland
- Faculty of Medicine, University of Technology, Katowice, Poland
| | | |
Collapse
|
24
|
Ko K, Verhagen AFTM, de Kroon TL, Morshuis WJ, van Garsse LAFM. Decision Making during the Learning Curve of Minimally Invasive Mitral Valve Surgery: A Focused Review for the Starting Minimally Invasive Surgeon. J Clin Med 2022; 11:jcm11205993. [PMID: 36294310 PMCID: PMC9604391 DOI: 10.3390/jcm11205993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 10/05/2022] [Indexed: 11/16/2022] Open
Abstract
Minimally invasive mitral valve surgery is evolving rapidly since the early 1990’s and is now increasingly adopted as the standard approach for mitral valve surgery. It has a long and challenging learning curve and there are many considerations regarding technique, planning and patient selection when starting a minimally invasive program. In the current review, we provide an overview of all considerations and the decision-making process during the learning curve.
Collapse
Affiliation(s)
- Kinsing Ko
- Cardiothoracic Surgery, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
- Correspondence:
| | - Ad F. T. M. Verhagen
- Cardiothoracic Surgery, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Thom L. de Kroon
- Cardiothoracic Surgery, St. Antonius Hospital Nieuwegein, 3435 CM Nieuwegein, The Netherlands
| | - Wim J. Morshuis
- Cardiothoracic Surgery, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | | |
Collapse
|
25
|
Petersen J, Naito S, Kloth B, Pecha S, Zipfel S, Alassar Y, Detter C, Conradi L, Reichenspurner H, Girdauskas E. Antegrade axillary arterial perfusion in 3D endoscopic minimally-invasive mitral valve surgery. Front Cardiovasc Med 2022; 9:980074. [PMID: 36247481 PMCID: PMC9561617 DOI: 10.3389/fcvm.2022.980074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/12/2022] [Indexed: 11/17/2022] Open
Abstract
Background Minimally-invasive (MIS) mitral valve (MV) surgery has become standard therapy in many cardiac surgery centers. While femoral arterial perfusion is the preferred cannulation strategy in MIS mitral valve surgery, retrograde arterial perfusion is known to be associated with an increased risk for cerebral atheroembolism, particularly in atherosclerosis patients. Therefore, antegrade perfusion may be beneficial in such cases. This analysis aimed to compare outcomes of antegrade axillary vs. retrograde femoral perfusion in the MIS mitral valve surgery. Methods This analysis includes 50 consecutive patients who underwent MIS between 2016 and 2020 using arterial cannulation of right axillary artery (Group A) due to severe aortic arteriosclerosis. Perioperative outcomes of the study group were compared with a historical control group of retrograde femoral perfusion (Group F) which was adjusted for age and gender (n = 50). Primary endpoint of the study was in-hospital mortality and perioperative cerebrovascular events. Results Patients in group A had a significantly higher perioperative risk as compared to Group F (EuroSCORE II: 3.9 ± 2.5 vs. 1.6 ± 1.5; p = 0.001; STS-Score: 2.1 ± 1.4 vs. 1.3 ± 0.6; p = 0.023). Cardiopulmonary bypass time (group A: 172 ± 46; group F: 178 ± 51 min; p = 0.627) and duration of surgery (group A: 260 ± 65; group F: 257 ± 69 min; p = 0.870) were similar. However, aortic cross clamp time was significantly shorter in group A as compared to group F (86 ± 20 vs. 111 ± 29 min, p < 0.001). There was no perioperative stroke in either groups. In-hospital mortality was similar in both groups (group A: 1 patient; group F: 0 patients; p = 0.289). In group A, one patient required central aortic repair due to intraoperative aortic dissection. No further cardiovascular events occurred in Group A patients. Conclusion Selective use of antegrade axillary artery perfusion in patients with systemic atherosclerosis shows similar in-hospital outcomes as compared to lower risk patients undergoing retrograde femoral perfusion. Patients with higher perioperative risk and severe atherosclerosis can be safely treated via the minimally invasive approach with antegrade axillary perfusion.
Collapse
Affiliation(s)
- Johannes Petersen
- Department of Cardiovascular Surgery, University Heart & Vascular Center, UKE Hamburg, Hamburg, Germany
- *Correspondence: Johannes Petersen,
| | - Shiho Naito
- Department of Cardiovascular Surgery, University Heart & Vascular Center, UKE Hamburg, Hamburg, Germany
| | - Benjamin Kloth
- Department of Cardiovascular Surgery, University Heart & Vascular Center, UKE Hamburg, Hamburg, Germany
- Department of Cardiothoracic Surgery, Augsburg University Hospital, Augsburg, Germany
| | - Simon Pecha
- Department of Cardiovascular Surgery, University Heart & Vascular Center, UKE Hamburg, Hamburg, Germany
| | - Svante Zipfel
- Department of Cardiovascular Surgery, University Heart & Vascular Center, UKE Hamburg, Hamburg, Germany
| | - Yousuf Alassar
- Department of Cardiovascular Surgery, University Heart & Vascular Center, UKE Hamburg, Hamburg, Germany
| | - Christian Detter
- Department of Cardiovascular Surgery, University Heart & Vascular Center, UKE Hamburg, Hamburg, Germany
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart & Vascular Center, UKE Hamburg, Hamburg, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart & Vascular Center, UKE Hamburg, Hamburg, Germany
| | - Evaldas Girdauskas
- Department of Cardiovascular Surgery, University Heart & Vascular Center, UKE Hamburg, Hamburg, Germany
- Department of Cardiothoracic Surgery, Augsburg University Hospital, Augsburg, Germany
| |
Collapse
|
26
|
Karsan RB, Allen R, Powell A, Beattie GW. Minimally-invasive cardiac surgery: a bibliometric analysis of impact and force to identify key and facilitating advanced training. J Cardiothorac Surg 2022; 17:236. [PMID: 36114506 PMCID: PMC9479391 DOI: 10.1186/s13019-022-01988-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 08/30/2022] [Indexed: 11/28/2022] Open
Abstract
Background The number of citations an article receives is a marker of its scientific influence within a particular specialty. This bibliometric analysis intended to recognise the top 100 cited articles in minimally-invasive cardiac surgery, to determine the fundamental subject areas that have borne considerable influence upon clinical practice and academic knowledge whilst also considering bibliometric scope. This is increasingly relevant in a continually advancing specialty and one where minimally-invasive cardiac procedures have the potential for huge benefits to patient outcomes.
Methods The Web of Science (Clarivate Analytics) data citation index database was searched with the following terms: [Minimal* AND Invasive* AND Card* AND Surg*]. Results were limited to full text English language manuscripts and ranked by citation number. Further analysis of the top 100 cited articles was carried out according to subject, author, publication year, journal, institution and country of origin. Results A total of 4716 eligible manuscripts were retrieved. Of the top 100 papers, the median (range) citation number was 101 (51–414). The most cited paper by Lichtenstein et al. (Circulation 114(6):591–596, 2006) published in Circulation with 414 citations focused on transapical transcatheter aortic valve implantation as a viable alternative to aortic valve replacement with cardiopulmonary bypass in selected patients with aortic stenosis. The Annals of Thoracic Surgery published the most papers and received the most citations (n = 35; 3036 citations). The United States of America had the most publications and citations (n = 52; 5303 citations), followed by Germany (n = 27; 2598 citations). Harvard Medical School, Boston, Massachusetts, published the most papers of all institutions. Minimally-invasive cardiac surgery pertaining to valve surgery (n = 42) and coronary artery bypass surgery (n = 30) were the two most frequent topics by a large margin. Conclusions This work establishes a comprehensive and informative analysis of the most influential publications in minimally-invasive cardiac surgery and outlines what constitutes a citable article. Undertaking a quantitative evaluation of the top 100 papers aids in recognising the contributions of key authors and institutions as well as guiding future efforts in this field to continually improve the quality of care offered to complex cardiac patients.
Collapse
|
27
|
Bartakke AA, Carmona-Garcia P, Fuster-Gonzalez M, Reparaz-Vives X. Manejo anestésico en la cirugía de reparación valvular mitral. CIRUGIA CARDIOVASCULAR 2022. [DOI: 10.1016/j.circv.2022.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
28
|
Sabatino ME, Okoh AK, Chao JC, Soto C, Baxi J, Salgueiro LA, Olds A, Ikegami H, Lemaire A, Russo MJ, Lee LY. Early Discharge After Minimally Invasive Aortic and Mitral Valve Surgery. Ann Thorac Surg 2022; 114:91-97. [PMID: 34419437 PMCID: PMC10893855 DOI: 10.1016/j.athoracsur.2021.07.047] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 06/07/2021] [Accepted: 07/13/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND We investigated patient outcomes in relation to their postoperative length of stay after minimally invasive valve surgery. METHODS All adults who survived elective, uncomplicated minimally invasive aortic or mitral valve surgery at a single center between 2012 and 2019 were classified by postoperative length of stay: early discharge (≤3 days) or late discharge (>3 days). The trend in early discharge was investigated over the study period, predictors of early discharge were identified using multivariate logistic regression modeling, and 1:1 propensity score matching was used to determine which patients in the late-discharge cohort had similar health to patients discharged early. Adjusted outcomes of 30-day mortality, readmission, and direct costs were analyzed. RESULTS Among 1262 consecutive patients undergoing minimally invasive valve surgery, 618 were elective and uncomplicated, 25% (n = 162) of whom were discharged early. The proportion of early-discharge patients increased over time (P for trend < .05). A history of congestive heart failure, stroke, or smoking and higher Society of Thoracic Surgeons predictive risk of mortality score negatively predicted early discharge (P < .05). Propensity score matching identified 101 (22%) late-discharge patients comparable with early-discharge patients. Adjusted 30-day mortality and readmission rates were comparable between cohorts. The median direct costs per patient ($20,046 vs $22,124, P < .05) were significantly lower in the early-discharge cohort. CONCLUSIONS In well-selected patients early discharge after minimally invasive valve surgery was associated with lower costs but comparable postoperative outcomes. About one-fifth of patients who remain in the hospital beyond postoperative day 3 may be candidates for earlier discharge.
Collapse
Affiliation(s)
- Marlena E Sabatino
- Department of Surgery, Division of Cardiothoracic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Alexis K Okoh
- Department of Surgery, Division of Cardiothoracic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey; Robert Wood Johnson University Hospital, New Brunswick, New Jersey
| | - Joshua C Chao
- Department of Surgery, Division of Cardiothoracic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey; Robert Wood Johnson University Hospital, New Brunswick, New Jersey
| | - Cassandra Soto
- Department of Surgery, Division of Cardiothoracic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Jigesh Baxi
- Department of Surgery, Division of Cardiothoracic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey; Robert Wood Johnson University Hospital, New Brunswick, New Jersey
| | - Lauren A Salgueiro
- Department of Surgery, Division of Cardiothoracic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Anna Olds
- Department of Surgery, Division of Cardiac Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Hirohisa Ikegami
- Department of Surgery, Division of Cardiothoracic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey; Robert Wood Johnson University Hospital, New Brunswick, New Jersey
| | - Anthony Lemaire
- Department of Surgery, Division of Cardiothoracic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey; Robert Wood Johnson University Hospital, New Brunswick, New Jersey
| | - Mark J Russo
- Department of Surgery, Division of Cardiothoracic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey; Robert Wood Johnson University Hospital, New Brunswick, New Jersey
| | - Leonard Y Lee
- Department of Surgery, Division of Cardiothoracic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey; Robert Wood Johnson University Hospital, New Brunswick, New Jersey.
| |
Collapse
|
29
|
Feirer N, Kornyeva A, Lang M, Sideris K, Voss B, Krane M, Lange R, Vitanova K. Non-robotic minimally invasive mitral valve repair: a 20-year single-centre experience. Eur J Cardiothorac Surg 2022; 62:6565842. [PMID: 35396837 DOI: 10.1093/ejcts/ezac223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 03/07/2021] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Minimally invasive mitral valve repair (MVR) promises major advantages over median sternotomy regarding cosmetic results and faster recovery. However, the long-term functional outcome of minimally invasive MVR has been questioned by critics because the limited access may not exclusively promise high-quality repair. This study examines the long-term outcome regarding survival and reoperation rate. METHODS All patients undergoing minimally invasive MVR from February 2000 until March 2020 were included in this study. Baseline clinical and surgical characteristics were summarized from the internal database. Primary end points were survival and freedom from reoperation, analysed via Kaplan-Meier curves. Secondary end points were periprocedural complications after minimally invasive MVR and incidence for recurrent mitral regurgitation >II°. RESULTS A total of 1194 patients underwent minimally invasive MVR, in 17 cases mitral valve replacement was required. The mean age was 55.1 years [47.6; 62.7]. The successful minimally invasive repair rate was 97%. The 30-day mortality was 0.6%. Survival was 96.7% [standard deviation (SD): 5.8%], 91.6% (SD: 1.1%) and 80.0% (SD: 11.2%) at 5, 10 and 20 years. The incidence of reoperation was 4.4% (SD: 3.2%), 10.3% (SD: 7.4%) and 16.7% (SD : 7.4%) at 5, 10 and 20 years, respectively. Concomitant procedures such as tricuspid valve repair and modified Cryo-maze procedure were performed in 263 cases. CONCLUSIONS Minimally invasive MVR for degenerative mitral regurgitation is safe, shows excellent functional long-term results and is associated with low perioperative and late mortality.
Collapse
Affiliation(s)
- Nina Feirer
- Department of Cardiovascular Surgery, German Heart Center Munich, Technical University Munich, Munich, Germany.,Insure (Institute for Translational Cardiac Surgery), Department of Cardiovascular Surgery, German Heart Center, Technical University Munich, Munich, Germany
| | - Anastasiya Kornyeva
- Department of Cardiovascular Surgery, German Heart Center Munich, Technical University Munich, Munich, Germany.,Insure (Institute for Translational Cardiac Surgery), Department of Cardiovascular Surgery, German Heart Center, Technical University Munich, Munich, Germany
| | - Miriam Lang
- Department of Cardiovascular Surgery, German Heart Center Munich, Technical University Munich, Munich, Germany.,Insure (Institute for Translational Cardiac Surgery), Department of Cardiovascular Surgery, German Heart Center, Technical University Munich, Munich, Germany
| | - Konstantinos Sideris
- Department of Cardiovascular Surgery, German Heart Center Munich, Technical University Munich, Munich, Germany.,Insure (Institute for Translational Cardiac Surgery), Department of Cardiovascular Surgery, German Heart Center, Technical University Munich, Munich, Germany
| | - Bernhard Voss
- Department of Cardiovascular Surgery, German Heart Center Munich, Technical University Munich, Munich, Germany.,Insure (Institute for Translational Cardiac Surgery), Department of Cardiovascular Surgery, German Heart Center, Technical University Munich, Munich, Germany
| | - Markus Krane
- Insure (Institute for Translational Cardiac Surgery), Department of Cardiovascular Surgery, German Heart Center, Technical University Munich, Munich, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, German Heart Center, Technical University Munich, Munich, Germany.,Division of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Rüdiger Lange
- Department of Cardiovascular Surgery, German Heart Center Munich, Technical University Munich, Munich, Germany.,Insure (Institute for Translational Cardiac Surgery), Department of Cardiovascular Surgery, German Heart Center, Technical University Munich, Munich, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, German Heart Center, Technical University Munich, Munich, Germany
| | - Keti Vitanova
- Department of Cardiovascular Surgery, German Heart Center Munich, Technical University Munich, Munich, Germany.,Insure (Institute for Translational Cardiac Surgery), Department of Cardiovascular Surgery, German Heart Center, Technical University Munich, Munich, Germany
| |
Collapse
|
30
|
Nakamae K, Oshitomi T, Uesugi H. A Hybrid Intervention for Post-Infarction Papillary Muscle Rupture with Severe Mitral Regurgitation: A Case Report. J Chest Surg 2022; 55:239-242. [PMID: 35292600 PMCID: PMC9178310 DOI: 10.5090/jcs.21.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/25/2022] [Accepted: 01/31/2022] [Indexed: 11/16/2022] Open
Abstract
Papillary muscle rupture with severe acute mitral regurgitation is a rare complication of acute myocardial infarction (AMI) that causes pulmonary congestion and cardiogenic shock. Moreover, it has a poor prognosis. Surgical intervention, including revascularization, is indicated; however, surgical mortality remains high. We report the case of an 85-year-old woman with cardiogenic shock from severe acute mitral regurgitation, in whom a hybrid intervention, combining percutaneous coronary intervention with mitral valve replacement via minithoracotomy, was performed after post-infarction papillary muscle rupture. She was discharged in a favorable clinical condition. We describe a novel hybrid intervention for treating a rare complication of AMI, which could minimize surgical invasion in elderly patients, prevent disuse syndrome after the intervention, and improve prognosis. However, mitral valve surgery via minithoracotomy for emergency cases requires technical proficiency, as well as collaboration with other healthcare professionals, and the choice to perform this procedure requires careful consideration.
Collapse
Affiliation(s)
- Kosuke Nakamae
- Division of Cardiovascular Surgery, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Takashi Oshitomi
- Division of Cardiovascular Surgery, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Hideyuki Uesugi
- Division of Cardiovascular Surgery, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| |
Collapse
|
31
|
Toscano A, Barbero C, Capuano P, Costamagna A, Pocar M, Trompeo A, Pasero D, Rinaldi M, Brazzi L. Chronic postsurgical pain and quality of life after right minithoracotomy mitral valve operations. J Card Surg 2022; 37:1585-1590. [PMID: 35274774 DOI: 10.1111/jocs.16400] [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: 12/12/2021] [Revised: 02/09/2022] [Accepted: 02/17/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Chronic postsurgical pain (CPSP) is a relatively common complication after cardio-thoracic operations with well-known consequences in terms of return to normal activities and quality of life. Little is known about the prevalence and severity of CPSP after minimally invasive cardiac surgery. The aim of this study was to measure the rate of CPSP in patients undergoing right minithoracotomy mitral valve (MV) surgery and to compare the effectiveness of different approaches to pain control. METHODS A prospective observational study was conducted between March 2019 and September 2020. All patients undergoing right minithoracotomy MV surgery treated with morphine, continuous serratus anterior plane block (SAPB), or continuous erector spinae plane block (ESPB) were included. The Brief Pain Inventory questionnaire was used to evaluate 6-month CPSP and quality of life. RESULTS A total of 100 patients were enrolled: postoperative pain control was obtained with morphine in 26 cases, with SAPB in 37 cases, and with ESPB in 37 cases. Median intensive care unit and hospital length of stay were 1 day and 6 days, respectively. Pain severity index was lower than 10 in 81 patients, and no differences were recorded between groups (p = .59). No patients reported chronic use of medications for pain management or severe pain interference in daily activities at follow-up. DISCUSSION Right minithoracotomy approach is not burdened by a high incidence of CPSP: pain severity index was lower than 10 in more than 90% of patients. Then, in our experience, chronic pain seems not to be related to the type of perioperative analgesia adopted.
Collapse
Affiliation(s)
- Antonio Toscano
- Department of Anesthesia, Critical Care and Emergency, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Cristina Barbero
- Department of Cardiovascular and Thoracic surgery, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Paolo Capuano
- Department of Anesthesia and Intensive Care, IRCCS-ISMETT, UPMC, Palermo, Italy
| | - Andrea Costamagna
- Department of Anesthesia, Critical Care and Emergency, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Marco Pocar
- Department of Cardiovascular and Thoracic surgery, Città della Salute e della Scienza Hospital, Turin, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Anna Trompeo
- Department of Anesthesia, Critical Care and Emergency, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Daniela Pasero
- Department of Medical, Surgical and Experimental Science, University of Sassari, Sassari, Italy
| | - Mauro Rinaldi
- Department of Cardiovascular and Thoracic surgery, Città della Salute e della Scienza Hospital, Turin, Italy.,Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Luca Brazzi
- Department of Anesthesia, Critical Care and Emergency, Città della Salute e della Scienza Hospital, Turin, Italy.,Department of Surgical Sciences, University of Turin, Turin, Italy
| |
Collapse
|
32
|
Misfeld M. Mitralklappenchirurgie der letzten 50 Jahre. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2022. [DOI: 10.1007/s00398-021-00477-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
33
|
Meidan TG, Lanfear AT, Squiers JJ, Hamandi M, Lytle BW, DiMaio JM, Smith RL. Robotic Mitral Valve Surgery After Prior Sternotomy. JTCVS Tech 2022; 13:46-51. [PMID: 35711230 PMCID: PMC9196136 DOI: 10.1016/j.xjtc.2022.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 01/12/2022] [Indexed: 11/17/2022] Open
Abstract
Objective Despite the recent increase in the use of minimally invasive approaches to mitral valve surgery in patients with a prior sternotomy, the outcomes of the robotic approach to mitral valve surgery in this patient population have not been examined. Methods We retrospectively reviewed 342 consecutive patients who underwent mitral valve surgery after a prior sternotomy between 2013 and 2020, in which the robotic approach was used in 21 patients (6.1%). We reviewed the clinical details of these 21 patients. Results The median age was 71 years [interquartile range 64.00, 74.00 years], and mean Society of Thoracic Surgeons Predicted Risk of Mortality was 4.2% ± 3.8%. The indication for mitral valve surgery was degenerative mitral valve disease in 33.3% (7/21), functional disease in 28.6% (6/21), mixed disease in 4.8% (1/21), rheumatic disease in 9.5% (2/21), and failed repair for degenerative disease in 23.8% (5/21). No cases required conversion from robotic assistance to alternative approaches, there were no intraoperative deaths, and intraoperative transesophageal echocardiogram confirmed complete elimination of mitral regurgitation in 90.5% (19/21) of cases. Thirty-day mortality was 0.0% (0/21), and 1-year mortality was 4.8% (1/21). There were no strokes or wound infections at 30 days, and 14.3% (3/21) of patients received intraoperative blood product transfusions. Conclusions The results of this retrospective review suggest that the robotic approach to mitral valve surgery in patients with a prior sternotomy is safe in experienced hands. Although some centers have considered prior sternotomy a relative contraindication to robotic mitral valve surgery, this approach is feasible and can be considered an option for experienced surgeons.
Collapse
Affiliation(s)
- Talia G. Meidan
- Baylor Scott & White Research Institute, Baylor Scott & White The Heart Hospital – Plano, Plano, Tex
- Address for reprints: Talia G. Meidan, BS, Baylor Scott & White The Heart Hospital – Plano, 1100 Allied Dr, Plano, TX 75093.
| | - Allison T. Lanfear
- Baylor Scott & White Research Institute, Baylor Scott & White The Heart Hospital – Plano, Plano, Tex
| | - John J. Squiers
- Baylor Scott & White Research Institute, Baylor Scott & White The Heart Hospital – Plano, Plano, Tex
| | - Mohanad Hamandi
- Baylor Scott & White Research Institute, Baylor Scott & White The Heart Hospital – Plano, Plano, Tex
| | - Bruce W. Lytle
- Department of Cardiothoracic Surgery, Baylor Scott & White The Heart Hospital – Plano, Plano, Tex
| | - J. Michael DiMaio
- Department of Cardiothoracic Surgery, Baylor Scott & White The Heart Hospital – Plano, Plano, Tex
| | - Robert L. Smith
- Department of Cardiothoracic Surgery, Baylor Scott & White The Heart Hospital – Plano, Plano, Tex
| | | |
Collapse
|
34
|
Lu A, Ye Y, Hu J, Wei N, Wei J, Lin B, Wang S. Case Series: Video-Assisted Minimally Invasive Cardiac Surgery During Pregnancy. Front Med (Lausanne) 2021; 8:781690. [PMID: 35004748 PMCID: PMC8727488 DOI: 10.3389/fmed.2021.781690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/09/2021] [Indexed: 11/16/2022] Open
Abstract
Surgical intervention is expected to improve maternal outcomes in pregnant patients with heart disease once the conservative treatment fails. For pregnant patients with heart disease, the risk of cardiac surgery under cardiopulmonary bypass (CPB) must be balanced due to the high fetal loss. The video-assisted minimally invasive cardiac surgery (MICS) has been progressively applied and shows advantages in non-pregnant patients over the years. We present five cases of pregnant women who underwent a video-assisted minimally invasive surgical approach for cardiac surgery and the management strategies. In conclusion, the video-assisted MICS is feasible and safe to pregnant patients, with good maternal and fetal outcomes under the multidisciplinary assessment and management.
Collapse
Affiliation(s)
- Anyi Lu
- Department of Anesthesiology, Guangdong Cardiovascular Institute & Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- College of Medicine, Shantou University, Shantou, China
| | - Yingxian Ye
- Department of Anesthesiology, Guangdong Cardiovascular Institute & Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiaqi Hu
- Department of Anesthesiology, Guangdong Cardiovascular Institute & Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ning Wei
- Department of Anesthesiology, Guangdong Cardiovascular Institute & Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jinfeng Wei
- Department of Anesthesiology, Guangdong Cardiovascular Institute & Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Bimei Lin
- Department of Operation Room, Guangdong Cardiovascular Institute & Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Sheng Wang
- Department of Anesthesiology, Guangdong Cardiovascular Institute & Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Anesthesiology, Linzhi People's Hospital, Linzhi, China
- *Correspondence: Sheng Wang
| |
Collapse
|
35
|
Olsthoorn JR, Heuts S, Houterman S, Maessen JG, Sardari Nia P. Effect of minimally invasive mitral valve surgery compared to sternotomy on short- and long-term outcomes: a retrospective multicentre interventional cohort study based on Netherlands Heart Registration. Eur J Cardiothorac Surg 2021; 61:1099-1106. [PMID: 34878099 DOI: 10.1093/ejcts/ezab507] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/25/2021] [Accepted: 11/01/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Minimally invasive mitral valve surgery (MIMVS) has been performed increasingly for the past 2 decades; however, large comparative studies on short- and long-term outcomes have been lacking. This study aims to compare short- and long-term outcomes of patients undergoing MIMVS versus median sternotomy (MST) based on real-world data, extracted from the Netherlands Heart Registration. METHODS Patients undergoing mitral valve surgery, with or without tricuspid valve, atrial septal closure and/or rhythm surgery between 2013 and 2018 were included. Primary outcomes were short-term morbidity and mortality and long-term survival. Propensity score matching analyses were performed. RESULTS In total, 2501 patients were included, 1776 were operated through MST and 725 using an MIMVS approach. After propensity matching, no significant differences in baseline characteristics persisted. There were no between-group differences in 30-day mortality (1.1% vs 0.7%, P = 0.58), 1-year mortality (2.6% vs 2.1%, P = 0.60) or perioperative stroke rate (1.1% vs 0.6%, P = 0.25) between MST and MIMVS, respectively. An increased rate of postoperative arrhythmia was observed in the MST group (31.3% vs 22.4%, P < 0.001). A higher repair rate was found in the MST group (80.9% vs 76.3%, P = 0.04). No difference in 5-year survival was found between the matched groups (95.0% vs 94.3%, P = 0.49). Freedom from mitral reintervention was 97.9% for MST and 96.8% in the MIMVS group (P = 0.01), without a difference in reintervention-free survival (P = 0.30). CONCLUSIONS The MIMVS approach is as safe as the sternotomy approach for the surgical treatment of mitral valve disease. However, it comes at a cost of a reduced repair rate and more reinterventions in the long term, in the real-world.
Collapse
Affiliation(s)
- Jules R Olsthoorn
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, Netherlands.,Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, Eindhoven, Netherlands
| | - Samuel Heuts
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | | | - Jos G Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
| | - Peyman Sardari Nia
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
| |
Collapse
|
36
|
Heim C, Müller PP, Massoudy P, Harig F, Nooh E, Weyand M, Czesla M. Pass On What You Have Learned: A Structured Mentor-Mentee Concept for the Implementation of a Minimally Invasive Mitral Valve Surgery Program. Eur Surg Res 2021; 63:98-104. [PMID: 34852340 DOI: 10.1159/000520431] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/21/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Starting a minimally invasive cardiac surgery (MICS) for mitral valve repair (MVR) program is challenging as it requires a new learning curve, but compromising surgical results at the same time is not acceptable. Here, we describe our surgical educational experience of starting a new MICS program at a university heart center in Germany. METHODS A dedicated team for the new MICS program including 2 cardiac surgeons, 1 cardiac anesthetist, 1 perfusionist, and 1 scrub nurse was chosen. The use of long shafted instruments was trained in a low-cost self-assembled MICS simulator, and the EACTS endoscopic dry lab course was visited. Thereafter, 1 MICS center was visited for direct observation and peer-to-peer education for 6 weeks. The mentor observed the first 10 cases performed by the mentee. The surgical mitral valve expertise of 1 single cardiac surgeon was retrospectively analyzed between April 2016 and April 2021. RESULTS Before the implementation of the MICS-MVR program, 18 mitral valve operations have been performed through sternotomy between April 2016 and October 2018 including 12 replacements and 6 ring annuloplasties. After starting the MICS-MVR program, 73 mitral operations have been performed by the same surgeon of which 53 video-assisted through minithoracotomy (72.6%). 83.1% of the MICS procedures included complex repair (n = 38) and ring annuloplasty (n = 6). Open heart MV surgery was necessary in 20 patients due to concomitant procedures (n = 8), redo procedures (n = 2), severe endocarditis (n = 4), or contraindication for MICS such as PAD (n = 6). There have been no deaths, 1 stroke, and 1 cardiac vascular (RCX) complication. Two patients required conversion to sternotomy and one pericardiocentesis in the long term. CONCLUSION Typically, excellent exposure and high repair rates of the MV has led us offer MICS approach to a majority of patients with isolated MV disease. Careful planning and a strict mentor-mentee concept facilitated a safe startup of an MICS program in a busy university heart center.
Collapse
Affiliation(s)
- Christian Heim
- University of Erlangen-Nuremberg, Cardiac Surgery, Erlangen, Germany
| | - Philipp P Müller
- University of Erlangen-Nuremberg, Cardiac Surgery, Erlangen, Germany
| | - Parwis Massoudy
- Department of Cardiac Surgery, Klinikum Passau, Passau, Germany
| | - Frank Harig
- University of Erlangen-Nuremberg, Cardiac Surgery, Erlangen, Germany
| | - Ehab Nooh
- University of Erlangen-Nuremberg, Cardiac Surgery, Erlangen, Germany
| | - Michael Weyand
- University of Erlangen-Nuremberg, Cardiac Surgery, Erlangen, Germany
| | - Markus Czesla
- Department of Cardiac Surgery, Klinikum Passau, Passau, Germany
| |
Collapse
|
37
|
Wang YC, Chi NH, Wang YC, Chen YS, Huang CH. Retrograde arterial perfusion and its outcome in robotic mitral valve surgery. Asian J Surg 2021; 45:1849-1854. [PMID: 34840044 DOI: 10.1016/j.asjsur.2021.10.013] [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: 07/12/2021] [Revised: 09/14/2021] [Accepted: 10/25/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Retrograde arterial perfusion is frequently used in minimally invasive cardiac surgery. However, there are concerns about its safety. METHODS A prospective observational cohort study was conducted in a tertiary university affiliated medical center during 2016-2018. Right side femoral artery and femoral vein are used for bypass route. We set cardiopulmonary bypass flow to 2.5-3.0 L/min/m2, and adjust pump flow rate to achieve adequate cerebral oxygenation. The upper limit of arterial cannula pressure was 250 mmHg. We divided our patients into four groups by average pump flow 2.2 L/min/m2 and average mean arterial pressure 45 mmHg. Compared outcomes included surgical mortality, hospital stay, ventilator use, neurological outcomes, acute kidney injury, distal limb saturations, and post-operative clinical complications. RESULTS We included 117 patients in this study, and all participants had successful mitral valve repair or replacement. Our longest CPB duration was 210 minutes. Surgical mortality was 1.7%. Hemorrhagic stroke rate was 1.7%, and there was no ischemic stroke event. CPB flow did not affect survival rate, hospital stay, intensive care unit stay, or serum lactate in post-operative day 1, but serum creatinine (mg/dL) level increased transiently in patients with low pump flow group(0.9 ± 0.4 vs 1.3 ± 0.7,p < 0.05). Cannulation limb had decreased oxygenation during CPB, but their oxygenation all recovered after surgery. No limb ischemia event happened. CONCLUSION Retrograde arterial perfusion is a safe method for minimally invasive cardiac surgery less than 3.5 hours under mild hypothermic status.
Collapse
Affiliation(s)
- Yi-Chia Wang
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, 10002, Taiwan
| | - Nai-Hsin Chi
- Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, Taipei, 10002, Taiwan
| | - Ya-Chen Wang
- Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, Taipei, 10002, Taiwan
| | - Yih-Sharng Chen
- Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, Taipei, 10002, Taiwan.
| | - Chi-Hsiang Huang
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, 10002, Taiwan.
| |
Collapse
|
38
|
Speziale G, Santarpino G, Moscarelli M, Di Bari N, Fiore F, Condello I, Bartolomucci F, Bellino MC, Nasso G. Minimally invasive mitral valve reconstruction: Is it an "all-comers" procedure? J Card Surg 2021; 37:2958-2962. [PMID: 34783083 DOI: 10.1111/jocs.16140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 11/02/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY The debate on the usefulness of the minimally invasive approach in mitral valve surgery is still open. The aim of this study is to describe a single-center case series of all comers undergoing minimally invasive mitral valve reconstruction. METHODS From 2010 to 2019, all the data recorded in the medical records of 893 consecutive patients undergoing mitral valve reconstruction through a right mini-thoracotomy were retrospectively collected. All patients were contacted by telephone for remote evaluation and integration of echocardiographic information on surgical results. RESULTS Mean age was 62.2 ± 14.5; 447 (50%) were female and mean log EuroSCORE was 2.5 ± 2.8%. At a mean follow-up of 4.1 ± 2.2 years (median 3.9), a total of 24 deaths (2.68%) were recorded. Twenty-four patients required rehospitalization for cardiac causes, 13 (1.4%) patients had at least moderate mitral insufficiency on follow-up echocardiography and, of these, seven patients underwent reoperation (0.8%). The cumulative hazard showed that 8.3% of patients experienced at least one event at 5 years. NYHA class improved significantly with 874 patients in NYHA class I, 13 in NYHA class II, 6 in NYHA class III, and 0 in NYHA class IV at last follow-up (p < .001 from baseline as reference point). CONCLUSIONS In a high-volume center, mitral valve surgery using a minimally invasive approach is a feasible treatment option for all-comers and is associated with excellent results that are maintained at clinical and echocardiographic follow-up.
Collapse
Affiliation(s)
- Giuseppe Speziale
- Department of Cardiac Surgery, Anthea Hospital, GVM Care&Research, Bari, Italy
| | - Giuseppe Santarpino
- Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy.,Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany
| | - Marco Moscarelli
- Department of Cardiac Surgery, Anthea Hospital, GVM Care&Research, Bari, Italy
| | - Nicola Di Bari
- Department of Cardiac Surgery, Aldo Moro University of Bari, Bari, Italy
| | - Flavio Fiore
- Department of Cardiac Surgery, Anthea Hospital, GVM Care&Research, Bari, Italy
| | - Ignazio Condello
- Department of Cardiac Surgery, Anthea Hospital, GVM Care&Research, Bari, Italy
| | | | - Maria C Bellino
- Department of Emergency and Organ Transplantation, Aldo Moro University of Bari, Bari, Italy
| | - Giuseppe Nasso
- Department of Cardiac Surgery, Anthea Hospital, GVM Care&Research, Bari, Italy
| |
Collapse
|
39
|
Radwan M, Salewski C, Hecker F, Miskovic A, Risteski P, Hlavicka J, Moritz A, Walther T, Holubec T. Mitral Valve Surgery via Upper Ministernotomy: Single-Centre Experience in More than 400 Patients. Medicina (B Aires) 2021; 57:medicina57111179. [PMID: 34833397 PMCID: PMC8625394 DOI: 10.3390/medicina57111179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/24/2021] [Accepted: 10/27/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Minimally invasive mitral valve (MV) surgery has emerged as an alternative to conventional sternotomy aiming to decrease surgical trauma. The aim of the study was to describe our experience with minimally invasive MV surgery through partial upper sternotomy (PUS) regarding short- and long-term outcomes. Methods: From January 2004 through March 2014, 419 patients with a median age of 58.9 years (interquartile range 18.7; 31.7% females) underwent isolated primary MV surgery using PUS. Myxomatous degenerative MV disease was the predominant pathology (77%). The patients’ mean EuroSCORE II risk profile was 3.9 ± 3.6%. Results: Mitral valve repair was performed in 384 patients (91.6%) and replacement in 35 patients (8.4%). Thirty-day mortality was 3.1%. In total, 29 (6.9%) deaths occurred during the follow-up. The overall estimated survival at 1, 5, and 10 years was 93.1 ± 1.3%, 87.1 ± 1.9%, and 81.1 ± 3.4%. Reoperation was necessary in 14 (3.3%) patients. The overall freedom from MV reoperation at 1, 5, and 10 years was 98.2 ± 0.7%, 96.1 ± 1.2%, and 86.7 ± 6.7% and the overall freedom from recurrent MV regurgitation > grade 2 in repaired valves at 1, 5, and 10 years was 98.8 ± 0.6%, 98.8 ± 0.6%, and 94.6 ± 3.3%. Conclusions: Minimally invasive MV surgery via PUS can be performed with particularly good early and late results. Thus, the PUS approach with the use of standard surgical instruments and cannulation techniques can be a valuable option for the MV surgery either in patients contraindicated or not suitable to minithoracotomy.
Collapse
Affiliation(s)
- Medhat Radwan
- Division of Thoracic and Cardiovascular Surgery, University of Tübingen, 72076 Tübingen, Germany; (M.R.); (C.S.); (P.R.)
| | - Christoph Salewski
- Division of Thoracic and Cardiovascular Surgery, University of Tübingen, 72076 Tübingen, Germany; (M.R.); (C.S.); (P.R.)
| | - Florian Hecker
- Department of Cardiovascular Surgery, University Hospital Frankfurt, Johann Wolfgang Goethe University Frankfurt, 60590 Frankfurt am Main, Germany; (F.H.); (A.M.); (J.H.); (A.M.); (T.W.)
| | - Aleksandra Miskovic
- Department of Cardiovascular Surgery, University Hospital Frankfurt, Johann Wolfgang Goethe University Frankfurt, 60590 Frankfurt am Main, Germany; (F.H.); (A.M.); (J.H.); (A.M.); (T.W.)
| | - Petar Risteski
- Division of Thoracic and Cardiovascular Surgery, University of Tübingen, 72076 Tübingen, Germany; (M.R.); (C.S.); (P.R.)
| | - Jan Hlavicka
- Department of Cardiovascular Surgery, University Hospital Frankfurt, Johann Wolfgang Goethe University Frankfurt, 60590 Frankfurt am Main, Germany; (F.H.); (A.M.); (J.H.); (A.M.); (T.W.)
| | - Anton Moritz
- Department of Cardiovascular Surgery, University Hospital Frankfurt, Johann Wolfgang Goethe University Frankfurt, 60590 Frankfurt am Main, Germany; (F.H.); (A.M.); (J.H.); (A.M.); (T.W.)
| | - Thomas Walther
- Department of Cardiovascular Surgery, University Hospital Frankfurt, Johann Wolfgang Goethe University Frankfurt, 60590 Frankfurt am Main, Germany; (F.H.); (A.M.); (J.H.); (A.M.); (T.W.)
| | - Tomas Holubec
- Department of Cardiovascular Surgery, University Hospital Frankfurt, Johann Wolfgang Goethe University Frankfurt, 60590 Frankfurt am Main, Germany; (F.H.); (A.M.); (J.H.); (A.M.); (T.W.)
- Correspondence: ; Tel.: +49-69630180094
| |
Collapse
|
40
|
Yokoyama Y, Kuno T, Takagi H, Briasoulis A, Ota T. Conventional sternotomy versus right mini-thoracotomy versus robotic approach for mitral valve replacement/repair; insights from a network meta-analysis. THE JOURNAL OF CARDIOVASCULAR SURGERY 2021; 63:492-497. [PMID: 34664809 DOI: 10.23736/s0021-9509.21.11902-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Minimally invasive cardiac surgery (MICS) through right mini-thoracotomy as well as robotic surgery has emerged for the last decade for mitral valve surgery. However, their risks and benefits are not fully understood yet. Thus, we conducted a network meta-analysis comparing the early- and long-term outcomes of mitral valve surgery via the conventional sternotomy, MICS, and robotic approaches. EVIDENCE ACQUISITION MEDLINE and EMBASE were searched through November, 2020 to identify randomized controlled trials (RCTs) and propensity-score matched (PSM) trials that investigated early- and long-term outcomes after mitral surgery via the conventional sternotomy, MICS, and robotic approaches. A subalalysis focusing on only subjects who initially underwent mitral valve repair was also conducted. EVIDENCE SYNTHESIS Our systematic literature search identified 2 RCTs and 19 PSM studies. MICS was related to significant risk reductions of permanent pacemaker implantation, surgical site infection, and transfusion compared to the sternotomy approach. The robotic approach was associated with a significant increase in re-exploration for bleeding compared to sternotomy. The subanalysis showed that MICS was associated with a significant increase requiring mitral valve reoperation compared to the sternotomy approach (hazard ratio [95% confidence interval] =7.33 [1.54-34.97], p=0.012), while no significant difference was observed between the sternotomy and the robotic approach. CONCLUSIONS Our network meta-analysis demonstrated that MICS was associated with better short-term outcomes compared to the sternotomy approach. Mitral valve reoperation was more frequent with MICS compared with the sternotomy approach after mitral valve repair, while no difference was observed between the sternotomy and robotic approaches.
Collapse
Affiliation(s)
- Yujiro Yokoyama
- Department of Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Toshiki Kuno
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA - .,Department of Cardiology, Montefiore Medical Center/Albert Einstein Medical College, New York, NY, USA
| | - Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Alexandros Briasoulis
- Division of Cardiovascular medicine, Section of Heart failure and Transplantation, University of Iowa, Iowa City, IA, USA
| | - Takeyoshi Ota
- Department of Surgery, The University of Chicago Medicine, Chicago, IL, USA
| |
Collapse
|
41
|
Barbero C, Rinaldi M, Pocar M, Cura Stura E, Calia C, Sebastiano V, Marchetto G, Filippini C, Boffini M, Ricci D. Endo-Aortic vs. Trans-Thoracic Clamping in Right Mini-Thoracotomy Mitral Valve Surgery: Outcome on Myocardial Protection. Front Cardiovasc Med 2021; 8:719687. [PMID: 34568461 PMCID: PMC8458726 DOI: 10.3389/fcvm.2021.719687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/13/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Perfusion strategies and aortic clamping techniques for right mini-thoracotomy mitral valve (MV) surgery have evolved over time and remarkable short- and long-term results have been reported. However, some concerns have raised about the adequacy of myocardial protection during the minimally invasive approach, particularly with the endo-aortic clamp (EAC). Aim of this study was to compare the efficacy, in terms of myocardial preservation, of the EAC with the trans-thoracic aortic clamp (TTC) in patients undergoing right mini-thoracotomy MV surgery. Methods: A single center, prospective observational study was performed on patients undergoing right mini-thoracotomy MV surgery with retrograde arterial perfusion and EAC or TTC. A propensity matched analysis was performed to compare the two groups. Primary outcome was the comparison between cardiac troponin T levels measured at different time-points after surgery. Results: Eighty EAC patients were compared with 37 TTC patients. No cases of myocardial infarction or low cardiac-output syndrome were overall reported. No differences were recorded in terms of stroke, peri-operative mortality, and in the release of myocardial markers, lactates levels and need for inotropic support at different time-points after surgery. CK-MB peak levels were significantly lower in the EAC group. Conclusion: Despite concerns arising about the EAC, this prospective study shows equivalence in terms of myocardial preservation of the EAC compared with the TTC in patients undergoing right mini-thoracotomy MV surgery.
Collapse
Affiliation(s)
- Cristina Barbero
- Department of Cardiovascular Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Mauro Rinaldi
- Department of Cardiovascular Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Marco Pocar
- Department of Cardiovascular Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Erik Cura Stura
- Department of Cardiovascular Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Claudia Calia
- Department of Cardiovascular Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Viviana Sebastiano
- Department of Cardiovascular Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Giovanni Marchetto
- Department of Cardiovascular Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Claudia Filippini
- Department of Anesthesia and Critical Care, University of Turin, Turin, Italy
| | - Massimo Boffini
- Department of Cardiovascular Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Davide Ricci
- Cardiac Surgery Unit, Scientific Institute for Research, Hospitalization and Healthcare Policlinic Hospital San Martino, Genova, Italy.,Department of Integrated Surgical and Diagnostic Sciences, University of Genova, Genova, Italy
| |
Collapse
|
42
|
Fouly MAH, Mousa TK. Minimally invasive mitral valve repair for degenerative etiology: a comparative study. THE CARDIOTHORACIC SURGEON 2021. [DOI: 10.1186/s43057-021-00055-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
There is a paucity of data comparing the minimally invasive mitral valve repair (MiMVr) to the conventional approach in patients with degenerative disease. Our objective was to compare the outcomes of MiMVr to the traditional mitral valve repair through median sternotomy in patients with degenerative mitral valve disease. We conducted a retrospective study on 215 patients classified into two groups. Group 1 (n = 80) included those who had mitral valve repair through a right anterolateral video-assisted mini-thoracotomy, and group 2 (n = 135) was approached through a conventional median sternotomy. We compared the preoperative, operative, and postoperative data between groups. Both groups had echocardiographic follow-ups after 6 and 12 months.
Results
There was no difference in gender distribution between both groups, and patients who had median sternotomy were significantly older (median 37 (Q1-Q3, 29-44) vs. 54 (48-60) years; P < 0.001). Cardiopulmonary bypass (134.5 (130-138.5) vs. 99 (97-104) min; P < 0.001) and ischemic times (99 (95-105.5) vs. 78 (75-81) min; P < 0.001) were significantly shorter in patients who had median sternotomy. Patients with MiMVr had significantly lower blood loss (370 (315-390) vs. 550 (490-600) ml; P < 0.001) and ICU stay (5 (4.5-6) vs. 7 (7-8) days; P < 0.001). There was no difference between both groups regarding re-exploration for bleeding, postoperative stroke, wound infection, renal failure, and mortality. As regards postoperative echocardiography follow-up at 6 and 12 months after the operation, there were no significant changes in the mean mitral valve gradient within each group; however, the mean gradient was lower in the MiMVr group (3 (3-3.5) vs. 4 (3-5) mmHg; P < 0.001). There was no significant difference between both groups regarding mitral regurgitation severity during 6 and 12 months follow-up.
Conclusion
Minimally invasive mitral valve repair in patients with degenerative pathology could be an alternative to conventional mitral valve surgery with comparable short-term and long-term outcomes.
Collapse
|
43
|
Cocchieri R, van de Wetering B, Stijnen M, Riezebos R, de Mol B. The Impact of Biomedical Engineering on the Development of Minimally Invasive Cardio-Thoracic Surgery. J Clin Med 2021; 10:jcm10173877. [PMID: 34501325 PMCID: PMC8432110 DOI: 10.3390/jcm10173877] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 11/16/2022] Open
Abstract
(1) We describe the boundary conditions for minimally invasive cardiac surgery (MICS) with the aim to reduce procedure-related patient injury and discomfort. (2) The analysis of the MICS work process and its demand for improved tools and devices is followed by a description of the relevant sub-specialties of bio-medical engineering: electronics, biomechanics, and materials sciences. (3) Innovations can represent a desired adaptation of an existing work process or a radical redesign of procedure and devices such as in transcutaneous procedures. Focused interaction between engineers, industry, and surgeons is always mandatory (i.e., a therapeutic alliance for addressing 'unmet patient or professional needs'. (4) Novel techniques in MICS lean heavily on usability and safe and effective use in dedicated hands. Therefore, the use of training and simulation models should enable skills selection, a safe learning curve, and maintenance of proficiency. (5) The critical technical steps and cost-benefit trade-offs during the journey from invention to application will be explained. Business considerations such as time-to-market and returns on investment do shape the cost-benefit room for commercial use of technology. Proof of clinical safety and effectiveness by physicians remains important, but establishing the technical reliability of MICS tools and warranting appropriate surgical skills come first.
Collapse
Affiliation(s)
- Riccardo Cocchieri
- Heart Center, OLVG Hospital, 1091 AC Amsterdam, The Netherlands; (R.C.); (R.R.)
| | - Bertus van de Wetering
- Department of Biomedical Engineering, Eindhoven University of Technology, 5600 MB Eindhoven, The Netherlands;
- LifeTec Group BV, 5611 ZS Eindhoven, The Netherlands
- Correspondence: (B.v.d.W.); (B.d.M.)
| | - Marco Stijnen
- Department of Biomedical Engineering, Eindhoven University of Technology, 5600 MB Eindhoven, The Netherlands;
- LifeTec Group BV, 5611 ZS Eindhoven, The Netherlands
| | - Robert Riezebos
- Heart Center, OLVG Hospital, 1091 AC Amsterdam, The Netherlands; (R.C.); (R.R.)
| | - Bastian de Mol
- Department of Biomedical Engineering, Eindhoven University of Technology, 5600 MB Eindhoven, The Netherlands;
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands
- Correspondence: (B.v.d.W.); (B.d.M.)
| |
Collapse
|
44
|
Bonatti J, Crailsheim I, Grabenwöger M, Winkler B. Minimally Invasive and Robotic Mitral Valve Surgery: Methods and Outcomes in a 20-Year Review. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2021; 16:317-326. [PMID: 34315268 DOI: 10.1177/15569845211012389] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In the mid- to late-1990s the cardiac surgery community began to apply limited incisions in mitral valve surgery. Ministernotomies and right-sided minithoracotomies were placed instead of the classic midline sternotomy. Adjunct technology such as videoscopy, advanced peripheral cannulation techniques, procedure specific long shafted surgical instruments, as well as surgical robots became available, and the procedures were refined in a stepwise fashion. In 2021, minimally invasive mitral valve repair is routine at many centers around the globe. We reviewed a total of 50 consecutive patient series published on the topic between 1999 and 2019. Three main versions of minimally invasive mitral valve surgery were applied in 20,539 patients. The surgical methods, their specific results, and the cumulative outcome of less invasive mitral valve surgery published over more than 20 years are reported and an integrated view on what less invasive mitral valve surgery can offer is presented.
Collapse
Affiliation(s)
- Johannes Bonatti
- 553088 Department of Cardiac and Vascular Surgery, Vienna Health Network - Clinic Floridsdorf, Austria.,Karl Landsteiner Institute of Cardiovascular Surgical Research, Vienna, Austria
| | - Ingo Crailsheim
- 553088 Department of Cardiac and Vascular Surgery, Vienna Health Network - Clinic Floridsdorf, Austria.,Karl Landsteiner Institute of Cardiovascular Surgical Research, Vienna, Austria
| | - Martin Grabenwöger
- 553088 Department of Cardiac and Vascular Surgery, Vienna Health Network - Clinic Floridsdorf, Austria.,Karl Landsteiner Institute of Cardiovascular Surgical Research, Vienna, Austria.,Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Bernhard Winkler
- 553088 Department of Cardiac and Vascular Surgery, Vienna Health Network - Clinic Floridsdorf, Austria.,Karl Landsteiner Institute of Cardiovascular Surgical Research, Vienna, Austria.,Center for Biomedical Research, Medical University of Vienna, Austria
| |
Collapse
|
45
|
Chen Y, Chen LW, Dai XF, Huang XS. Open Seldinger-guided peripheral femoro-femoral cannulation technique for totally endoscopic cardiac surgery. J Cardiothorac Surg 2021; 16:199. [PMID: 34294106 PMCID: PMC8296695 DOI: 10.1186/s13019-021-01584-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/10/2021] [Indexed: 12/29/2022] Open
Abstract
Background The cannulation technique used in totally endoscopic cardiac surgery has a significant impact on the overall prognosis of patients. However, there are no large cohort studies to discuss it. Here we report on our research of using open Seldinger-guided technique to establish femoro-femoral cardiopulmonary bypass during totally endoscopic cardiac surgery and evaluate its safety and efficacy. Methods The institutional database from 2017 to 2020 was retrospectively reviewed to find cases in which totally endoscopic cardiac surgery was performed. We identified 214 consecutive patients who underwent totally endoscopic cardiac surgery with peripheral femoro-femoral cannulation. All patients underwent femoral artery cannulation. Of these, 201 were cannulated in the femoral vein and 13 were cannulated in the femoral vein combined with internal jugular cannulation. The technique involves surgically exposing the femoral vessel, setting up purse-string over the vessels and then inserting a guidewire into the femoral vessel without a vascular incision, followed by exchange of the guidewire with a cannula. Results Surgery indications included mitral valve disease in 82.71% (177/214), atrial septal defect in 11.68% (25/214) and tricuspid regurgitation in the remaining 5.61% (12/214). Hospital survival was 98.60% (211/214). There were no cases of stroke and postoperative limb ischaemia. No femoral vessel injuries or wound infections was observed. No late pseudoaneurysms were evident. Conclusion The open Seldinger-guided femoro-femoral cannulation technique is effective and safe. We highly recommend this technique, given its safety, simplicity and speed under direct vision. The limited manipulation of the vessels under direct vision minimizes the risk of local complications. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-021-01584-x.
Collapse
Affiliation(s)
- Yi Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China.,Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, China
| | - Liang-Wan Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Xiao-Fu Dai
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Xue-Shan Huang
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China. .,Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, China.
| |
Collapse
|
46
|
Cetinkaya A, Geier A, Bramlage K, Hein S, Bramlage P, Schönburg M, Choi YH, Richter M. Long-term results after mitral valve surgery using minimally invasive versus sternotomy approach: a propensity matched comparison of a large single-center series. BMC Cardiovasc Disord 2021; 21:314. [PMID: 34174818 PMCID: PMC8236182 DOI: 10.1186/s12872-021-02121-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 06/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mitral valve (MV) surgery has traditionally been performed by conventional sternotomy (CS), but more recently minimally invasive surgery (MIS) has become another treatment option. The aim of this study is to compare short- and long-term results of MV surgery after CS and MIS. METHODS This study was a retrospective propensity-matched analysis of MV operations between January 2005 and December 2015. RESULTS Among 1357 patients, 496 underwent CS and 861 MIS. Matching resulted in 422 patients per group. The procedure time was longer with MIS than CS (192 vs. 185 min; p = 0.002) as was cardiopulmonary bypass time (133 vs. 101 min; p < 0.001) and X-clamp time (80 vs. 71 min; p < 0.001). 'Short-term' successful valve repair was higher with MIS (96.0% vs. 76.0%, p < 0.001). Length of hospital stay was shorter in MIS than CS patients (10 vs. 11 days; p = 0.001). There was no difference in the overall 30-day mortality rate. Cardiovascular death was lower after MIS (1.2%) compared with CS (3.8%; OR 0.30; 95%CI 0.11-0.84). The difference did not remain significant after adjustment for procedural differences (aOR 0.40; 95%CI 0.13-1.25). Pacemaker was required less often after MIS (3.3%) than CS (11.2%; aOR 0.31; 95%CI 0.16-0.61), and acute renal failure was less common (2.1% vs. 11.9%; aOR 0.22; 95%CI 0.10-0.48). There were no significant differences with respect to rates of stroke, myocardial infarction or repeat MV surgery. The 7-year survival rate was significantly better after MIS (88.5%) than CS (74.8%; aHR 0.44, 95%CI 0.31-0.64). CONCLUSION This study demonstrates that good results for MV surgery can be obtained with MIS, achieving a high MV repair rate, low peri-procedural morbidity and mortality, and improved long-term survival.
Collapse
Affiliation(s)
- Ayse Cetinkaya
- Department of Cardiac Surgery, Kerckhoff-Heart Center Bad Nauheim, Justus-Liebig University Giessen, Benekestraße 2-8, 61231, Bad Nauheim, Germany
| | - Anna Geier
- Department of Cardiac Surgery, Kerckhoff-Heart Center Bad Nauheim, Justus-Liebig University Giessen, Benekestraße 2-8, 61231, Bad Nauheim, Germany
| | - Karin Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Stefan Hein
- Department of Cardiac Surgery, Kerckhoff-Heart Center Bad Nauheim, Justus-Liebig University Giessen, Benekestraße 2-8, 61231, Bad Nauheim, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Markus Schönburg
- Department of Cardiac Surgery, Kerckhoff-Heart Center Bad Nauheim, Justus-Liebig University Giessen, Benekestraße 2-8, 61231, Bad Nauheim, Germany
| | - Yeong-Hoon Choi
- Department of Cardiac Surgery, Kerckhoff-Heart Center Bad Nauheim, Justus-Liebig University Giessen, Benekestraße 2-8, 61231, Bad Nauheim, Germany.
| | - Manfred Richter
- Department of Cardiac Surgery, Kerckhoff-Heart Center Bad Nauheim, Justus-Liebig University Giessen, Benekestraße 2-8, 61231, Bad Nauheim, Germany
| |
Collapse
|
47
|
Ler A, Wu D, Xian OZ, Sazzad F, Swee KG, Kofidis T. Automated Suture Fastener Gaining Complete Commitment: Cumulative Propensity-Matched Comparison with Hand-Tied Knot in Heart Valve Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2021; 16:334-342. [PMID: 34130533 DOI: 10.1177/15569845211011617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The COR-KNOT® device is an automated suture fastener in which there is currently no consensus on its role in heart valve surgery. Our aim was thus to conduct a one-to-one comparison of clinical outcomes with a hand-tied control cohort. METHODS We performed a single-center, cumulative propensity-matched retrospective cohort study on patients undergoing heart valve surgery from 1 January 2015 to 13 February 2020. Propensity score matching was performed on 693 patients, dividing them into matched COR-KNOT® (n = 124) and hand-tied (n = 124) groups. RESULTS Data on baseline demographics, operative details, and clinical outcomes were analyzed and compared between the groups. The patients in both the COR-KNOT® and control groups were well-matched. For the median sternotomy (MS) all procedures subgroup, use of COR-KNOT® was associated with a decrease of around 49 min in CPB time (220.00 [168.00 to 256.00] vs 70.50 [134.00 to 236.75] min, P = 0.006) and around 32 min in ACC time (145.00 [109.00 to 189.00] vs 112.50 [81.00 to 161.75] min, P = 0.008). In the MS valve and CABG subgroup, use of COR-KNOT® was associated with a 70 min reduction in overall operation time (401.00 [354.25 to 468.75] vs 330.50 [288.50 to 370.50] min, P = 0.013), 63 min reduction in CPB time (216.50 [191.75 to 283.25] vs 153.00 [124.75 to 207.50] min, P = 0.004) and 45 min reduction in ACC time (146.00 [134.50 to 205.50] vs 100.50 [71.50 to 150.75] min, P = 0.003). CONCLUSIONS In heart valve surgery, use of the automated suture fastener was associated with shorter CPB and ACC times. Additionally, we determined that clinical outcomes are most likely unaffected by the use of COR-KNOT®.
Collapse
Affiliation(s)
- Ashlynn Ler
- 162643 Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, Singapore.,School of Medicine, National University of Ireland, Galway, Ireland
| | - Duoduo Wu
- 162643 Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, Singapore.,63751 Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ong Zhi Xian
- 162643 Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, Singapore.,63751 Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Faizus Sazzad
- 162643 Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, Singapore.,63751 Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,59053 Cardiovascular Research Institute, National University of Singapore, Singapore
| | - Kang Giap Swee
- 162643 Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, Singapore.,63751 Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,37580 National University Heart Center, National University Health System, Singapore
| | - Theo Kofidis
- 162643 Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, Singapore.,63751 Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,59053 Cardiovascular Research Institute, National University of Singapore, Singapore.,37580 National University Heart Center, National University Health System, Singapore
| |
Collapse
|
48
|
Bjelic M, Ayers B, Paic F, Bernstein W, Barrus B, Chase K, Gu Y, Alexis JD, Vidula H, Cheyne C, Prasad S, Gosev I. Study results suggest less invasive HeartMate 3 implantation is a safe and effective approach for obese patients. J Heart Lung Transplant 2021; 40:990-997. [PMID: 34229916 DOI: 10.1016/j.healun.2021.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/27/2021] [Accepted: 06/01/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Historically, obesity was considered a relative contraindication to left ventricular assist device (LVAD) implantation with less invasive surgery (LIS). The present study aimed to compare the outcomes of obese patients who underwent LVAD implantation through LIS with those who received full sternotomy (FS) implantation. METHODS We retrospectively reviewed all patients implanted with HeartMate 3 LVAD in our institution between September 2015 and June 2020. Obese patients (BMI ≥ 30 kg/m2) were included and dichotomized based on surgical approach into the FS or LIS cohort. RESULTS Of 231 implanted patients, 107 (46%) were obese and included in the study. FS was performed in 26 (24%) patients and LIS approach in 81 (76%) patients. Preoperative patient characteristics were similar between the cohorts. Postoperatively, patients in LIS cohort had less bleeding (p = 0.029), fewer transfusions (p = 0.042), shorter duration of inotropic support (p = 0.049), and decreased incidence of severe RV failure (11.1% vs 30.8%, p = 0.028). Survival to discharge for the obese population was 87.5% overall and did not differ based on an approach (91.4% LIS vs 76.9% FS, p = 0.079). More LIS patients were discharged home (60.0% vs 82.4%, p = 0.041) rather than to rehabilitation center. CONCLUSION Our results showed that the LIS approach in obese patients is associated with fewer postoperative complications and a trend towards better short-term survival. These results suggest that less invasive LVAD implantation is a safe and effective approach for obese patients. Future prospective randomized trials are required to substantiate these results.
Collapse
Affiliation(s)
- Milica Bjelic
- Division of Cardiac Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Brian Ayers
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Frane Paic
- Department of Medical Biology and Genetics, University of Zagreb Medical School, Zagreb, Croatia
| | - Wendy Bernstein
- Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, New York
| | - Bryan Barrus
- Division of Cardiac Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Karin Chase
- Division of Cardiac Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Yang Gu
- Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, New York
| | - Jeffrey D Alexis
- Division of Cardiology, Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | - Himabindu Vidula
- Division of Cardiology, Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | - Christina Cheyne
- Division of Cardiology, Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | - Sunil Prasad
- Division of Cardiac Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Igor Gosev
- Division of Cardiac Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, New York.
| |
Collapse
|
49
|
Wei P, Liu J, Ma J, Zhang Y, Chen Z, Liu Y, Tan T, Wu H, Chen J, Zhuang J, Guo H. Long-term outcomes of a totally thoracoscopic approach for reoperative mitral valve replacement: a propensity score matched analysis. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:987. [PMID: 34277787 PMCID: PMC8267274 DOI: 10.21037/atm-21-2407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/28/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND This study aimed to summarize the perioperative and long-term outcomes of patients with previous mitral valve surgery (MVS) undergoing reoperative mitral valve replacement (MVR). METHODS Data for all reoperative mitral valve replacements (re-MVRs) with or without concomitant tricuspid surgery were analyzed from Guangdong Provincial People's Hospital between January 2013 and December 2019. Propensity score matching resulted in 30 matched pairs with improved balance after matching in baseline covariates. Perioperative data and long-term clinical outcomes were analyzed. RESULTS Results are based on the matched cohorts between the two groups. The in-hospital mortality was 3.3% (two deaths) in the entire cohort and was not significantly different between the median sternotomy (MS) group and the totally thoracoscopic (TT) group. Most patients in the TT group had their tracheal intubation removed within 24 hours of surgery. The TT group had a diminished requirement for blood transfusion and a reduced 4-day postoperative chest tube drainage amount. The incidence of early major complications, including all-cause death and reoperation due to bleeding, was lower in the TT group. No significant differences were observed in the 7-year survival probability between the two groups. CONCLUSIONS The encouraging results regarding the perioperative and long-term outcomes of patients who underwent a TT re-MVR show that this approach is particularly beneficial for patients requiring reoperation.
Collapse
Affiliation(s)
- Peijian Wei
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Jian Liu
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
| | - Jiexu Ma
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Yuyuan Zhang
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
| | - Zhao Chen
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
| | - Yanjun Liu
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
| | - Tong Tan
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Hongxiang Wu
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
| | - Jimei Chen
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
| | - Jian Zhuang
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
| | - Huiming Guo
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
| |
Collapse
|
50
|
Huang LC, Xu QC, Chen DZ, Dai XF, Chen LW. Hospital outcome of concomitant tricuspid annuloplasty during totally endoscopic mitral valve surgery: a propensity matched study. J Thorac Dis 2021; 13:3042-3050. [PMID: 34164195 PMCID: PMC8182534 DOI: 10.21037/jtd-20-3302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background This study aimed to determine how concomitant tricuspid annuloplasty (TAP) affects the clinical outcomes of patients undergoing totally endoscopic mitral valve surgery. Methods This was a single-centre, retrospective study. Between January 2019 and June 2020, 143 patients who underwent totally endoscopic mitral valve surgery in our institution were enrolled. Ninety-two patients who underwent isolated mitral valve surgery were categorized into the minimally invasive mitral valve surgery (MIMVS) group (n=92), and patients who underwent mitral valve surgery with concomitant TAP were categorized into the MIMVS-TAP (n=51) group. Clinical data were collected from all patients, including demographic and perioperative data. We conducted propensity score matching (PSM) by using one-to-one ratio nearest-neighbour matching for baseline demographic data and tricuspid valve-related parameters. Forty patients in each group were matched in this way. Parametric and nonparametric tests were performed for data analysis. Results Statistically, postoperative mortality within 30 days was not significantly different between the two groups (P=1). No differences were found in serious adverse events, such as stroke or third-degree conduction block, between the two groups after 1:1 PSM (P=1 and P=0.480, respectively). The mean operation time for the MIMVS+TAP group was longer (232.13±36.05 min) than that for the MIMVS group (204.25±28.49 min; P<0.001). The same was true for the cardiopulmonary bypass (CPB) time (169.48±25.96 vs. 153.10±23.00 min; P=0.004) and aortic clamp time (110.80±17.37 vs. 101.00±14.38 min; P=0.005). The duration of the intensive care unit stay and the overall postoperative length of stay were not different between the two groups (P=0.734 and P=0.472, respectively). The postoperative systolic pulmonary artery pressure differed between the two groups [38.00±8.45 (MIMVS); 33.65±7.34 (MIMVS + TAP), P=0.022]. Conclusions Our study showed that totally endoscopic mitral valve surgery with concomitant TAP is just as safe and effective as isolated totally endoscopic mitral valve surgery, even with a long surgery duration. Our study also suggested that totally endoscopic mitral valve surgery with concomitant TAP can improve tricuspid function in patients.
Collapse
Affiliation(s)
- Ling-Chen Huang
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Cardio-thoracic Surgery, Fujian Medical University, Fuzhou, China
| | - Qi-Chen Xu
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Dao-Zhong Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Xiao-Fu Dai
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Liang-Wan Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China.,Fujian Key Laboratory of Cardio-thoracic Surgery, Fujian Medical University, Fuzhou, China
| |
Collapse
|