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Liu Z, Maimaitiaili A, Ma X, Dong S, Wei W, Wang Q, Chen Q, Liu J, Guo Z. Initial experience and favorable outcomes on cannulation strategies and surgical platform construction in fully video-assisted thoracoscopic cardiac surgery. Front Cardiovasc Med 2024; 11:1414333. [PMID: 39175634 PMCID: PMC11338890 DOI: 10.3389/fcvm.2024.1414333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 07/29/2024] [Indexed: 08/24/2024] Open
Abstract
Background Minimally invasive cardiac surgery offers numerous advantages that patients and surgeons desire. This surgical platform encompasses cannulation strategies for cardiopulmonary bypass, optimal surgical access points, and high-quality visualization techniques. Traditional peripheral cannulation methods, though convenient, possess inherent limitations and carry the potential for complications such as retrograde dissection, stroke, or neurologic sequelae. Conversely, central cannulation may be ideally suited to circumvent the disadvantages above. Fully video-assisted thoracoscopy cardiac surgery represents a state-of-the-art platform, offering surgeons an unparalleled surgical view. This analysis aimed to delineate the efficacy and safety of transthoracic central cannulation strategies and the surgical platform during fully video-assisted thoracoscopy cardiac surgery. Methods Between October 2022 and February 2024, we identified a cohort of 85 consecutive patients with cardiopulmonary bypass undergoing fully video-assisted thoracoscopy cardiac surgery at our institutions. The patients' mean age was 41.09 ± 14.01 years, ranging from 18 to 75 years. The mean weight was 64.34 ± 10.59 kg (ranging from 49 to 103 kg). Congenital heart disease repair accounted for the highest proportion, with 43 cases (50.59%). Mitral valve surgery and left atrium Myxoma resections accounted for 29.41%. Specifically, this included 14 mitral valve repairs, five mitral valve replacements, and six left atrium myxoma resections. Aortic valve replacements constitute 20% of all cases. Results A total of 85 adult patients underwent fully video-assisted thoracoscopy cardiac surgery. The average CPB time was 83.26 ± 28.26 min, while the aortic cross-clamp time averaged 51.87 ± 23.91 min. The total operation time (skin to skin) averaged 173.8 ± 37.08 min. The mean duration of mechanical ventilation was 5.58 ± 3.43 h, ICU stay was 20.04 ± 2.83 h (ranging from 15.5 to 34 h), and postoperative hospital stay was 5.55 ± 0.87 days. No patients required conversion to thoracotomy and unplanned reoperations due to various reasons. There were no in-hospital deaths, strokes, myocardial infarctions, aortic dissections, or renal failure. No patient developed wound soft tissue infection. Conclusions Fully video-assisted thoracoscopy cardiac surgery utilizing central cannulation strategies is a reliable, cost-effective platform with a low risk of complications and a potential solution for patients facing contraindications for peripheral cannulation.
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Affiliation(s)
- Zihou Liu
- Department of Cardiovascular Surgery, Clinical School of Thoracic, Tianjin Medical University, Tianjin, China
- Department of Cardiovascular Surgery, Chest Hospital, Tianjin University, Tianjin, China
- Department of Cardiothoracic Surgery, Renmin Hospital of Hotan Prefecture, Xinjiang Uygur Autonomous Region, Xinjiang, China
| | - Abulizi Maimaitiaili
- Department of Cardiothoracic Surgery, Renmin Hospital of Hotan Prefecture, Xinjiang Uygur Autonomous Region, Xinjiang, China
| | - Xiaozhong Ma
- Department of Cardiovascular Surgery, Clinical School of Thoracic, Tianjin Medical University, Tianjin, China
- Department of Cardiovascular Surgery, Chest Hospital, Tianjin University, Tianjin, China
| | - Shuangfeng Dong
- Department of Cardiothoracic Surgery, Renmin Hospital of Hotan Prefecture, Xinjiang Uygur Autonomous Region, Xinjiang, China
| | - Wei Wei
- Department of Cardiothoracic Surgery, Renmin Hospital of Hotan Prefecture, Xinjiang Uygur Autonomous Region, Xinjiang, China
| | - Qiang Wang
- Department of Cardiovascular Surgery, Clinical School of Thoracic, Tianjin Medical University, Tianjin, China
- Department of Cardiovascular Surgery, Chest Hospital, Tianjin University, Tianjin, China
| | - Qingliang Chen
- Department of Cardiovascular Surgery, Clinical School of Thoracic, Tianjin Medical University, Tianjin, China
- Department of Cardiovascular Surgery, Chest Hospital, Tianjin University, Tianjin, China
| | - Jianshi Liu
- Department of Cardiovascular Surgery, Clinical School of Thoracic, Tianjin Medical University, Tianjin, China
- Department of Cardiovascular Surgery, Chest Hospital, Tianjin University, Tianjin, China
| | - Zhigang Guo
- Department of Cardiovascular Surgery, Clinical School of Thoracic, Tianjin Medical University, Tianjin, China
- Department of Cardiovascular Surgery, Chest Hospital, Tianjin University, Tianjin, China
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Hussain S, Swystun AG, Caputo M, Angelini GD, Vohra HA. A review and meta-analysis of conventional sternotomy versus minimally invasive mitral valve surgery for degenerative mitral valve disease focused on the last decade of evidence. Perfusion 2024; 39:988-997. [PMID: 37145960 DOI: 10.1177/02676591231174579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
OBJECTIVES Early meta-analyses comparing minimally invasive mitral valve surgery (MIMVS) with conventional sternotomy (CS) have determined the safety of MIMVS. We performed this review and meta-analysis based on studies from 2014 onwards to examine the differences in outcomes between MIMVS and CS. Specifically, some outcomes of interest included renal failure, new onset atrial fibrillation, mortality, stroke, reoperation for bleeding, blood transfusion and pulmonary infection. METHODS A systematic search was performed in six databases for studies comparing MIMVS with CS. Although the initial search identified 821 papers in total, nine studies were suitable for the final analysis. All studies included compared CS with MIMVS. The Mantel - Haenszel statistical method was chosen due the use of inverse variance and random effects. A meta-analysis was performed on the data. RESULTS MIMVS had significantly lower odds of renal failure (OR: 0.52; 95% CI 0.37 to 0.73, p < 0.001), new onset atrial fibrillation (OR: 0.78; 95% CI 0.67 to 0.90, p < 0.001), reduced prolonged intubation (OR: 0.50; 95% CI 0.29 to 0.87, p = 0.01) and reduced mortality (OR: 0.58; 95% CI 0.38 to 0.87, p < 0.01). MIMVS had shorter ICU stay (WMD: -0.42; 95% CI -0.59 to -0.24, p < 0.001) and shorter time to discharge (WMD: -2.79; 95% CI -3.86 to -1.71, p < 0.001). CONCLUSION In the modern era, MIMVS for degenerative disease is associated with improved short-term outcomes when compared to the CS.
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Affiliation(s)
| | | | - Massimo Caputo
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol, UK
| | | | - Hunaid A Vohra
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol, UK
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Nicolotti D, Grossi S, Palermo V, Pontone F, Maglietta G, Diodati F, Puntoni M, Rossi S, Caminiti C. Procalcitonin for the diagnosis of postoperative bacterial infection after adult cardiac surgery: a systematic review and meta-analysis. Crit Care 2024; 28:44. [PMID: 38326921 PMCID: PMC10848477 DOI: 10.1186/s13054-024-04824-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/29/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND AND AIMS Patients undergoing cardiac surgery are subject to infectious complications that adversely affect outcomes. Rapid identification is essential for adequate treatment. Procalcitonin (PCT) is a noninvasive blood test that could serve this purpose, however its validity in the cardiac surgery population is still debated. We therefore performed a systematic review and meta-analysis to estimate the accuracy of PCT for the diagnosis of postoperative bacterial infection after cardiac surgery. METHODS We included studies on adult cardiac surgery patients, providing estimates of test accuracy. Search was performed on PubMed, EmBase and WebOfScience on April 12th, 2023 and rerun on September 15th, 2023, limited to the last 10 years. Study quality was assessed with the QUADAS-2 tool. The pooled measures of performance and diagnostic accuracy, and corresponding 95% Confidence Intervals (CI), were calculated using a bivariate regression model. Due to the variation in reported thresholds, we used a multiple-thresholds within a study random effects model for meta-analysis (diagmeta R-package). RESULTS Eleven studies were included in the systematic review, and 10 (2984 patients) in the meta-analysis. All studies were single-center with observational design, five of which with retrospective data collection. Quality assessment highlighted various issues, mainly concerning lack of prespecified thresholds for the index test in all studies. Results of bivariate model analysis using multiple thresholds within a study identified the optimal threshold at 3 ng/mL, with a mean sensitivity of 0.67 (0.47-0.82), mean specificity of 0.73 (95% CI 0.65-0.79), and AUC of 0.75 (IC95% 0.29-0.95). Given its importance for practice, we also evaluated PCT's predictive capability. We found that positive predictive value is at most close to 50%, also with a high prevalence (30%), and the negative predictive value was always > 90% when prevalence was < 20%. CONCLUSIONS These results suggest that PCT may be used to help rule out infection after cardiac surgery. The optimal threshold of 3 ng/mL identified in this work should be confirmed with large, well-designed randomized trials that evaluate the test's impact on health outcomes and on the use of antibiotic therapy. PROSPERO Registration number CRD42023415773. Registered 22 April 2023.
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Affiliation(s)
- Davide Nicolotti
- Department of Anesthesia and Intensive Care Medicine, University Hospital of Parma, Parma, Italy
| | - Silvia Grossi
- Department of Anesthesia and Intensive Care Medicine, University Hospital of Parma, Parma, Italy
| | - Valeria Palermo
- Department of Anesthesia and Intensive Care Medicine, University Hospital of Parma, Parma, Italy
| | - Federico Pontone
- Department of Anesthesia and Intensive Care Medicine, University Hospital of Parma, Parma, Italy
| | - Giuseppe Maglietta
- Clinical and Epidemiological Research Unit, University Hospital of Parma, Parma, Italy.
| | - Francesca Diodati
- Clinical and Epidemiological Research Unit, University Hospital of Parma, Parma, Italy
| | - Matteo Puntoni
- Clinical and Epidemiological Research Unit, University Hospital of Parma, Parma, Italy
| | - Sandra Rossi
- Department of Anesthesia and Intensive Care Medicine, University Hospital of Parma, Parma, Italy
| | - Caterina Caminiti
- Clinical and Epidemiological Research Unit, University Hospital of Parma, Parma, Italy
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Ntinopoulos V, Rodriguez Cetina Biefer H, Papadopoulos N, Dushaj S, Haeussler A, Dzemali O. Isolated Minimally Invasive Mitral Valve Surgery in Octogenarians: Perioperative Outcome. Gerontology 2023; 69:1211-1217. [PMID: 37647873 DOI: 10.1159/000533560] [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: 02/18/2023] [Accepted: 08/08/2023] [Indexed: 09/01/2023] Open
Abstract
INTRODUCTION Despite the feasibility, safety, and excellent outcomes of mitral valve surgery through a right mini-thoracotomy, there is data paucity about its use in octogenarians. In this study, we assess the outcomes of mitral valve surgery via right mini-thoracotomy in octogenarians. METHODS We performed a retrospective analysis of the in-hospital perioperative data of 38 octogenarian patients with severe mitral regurgitation undergoing isolated mitral valve surgery via right mini-thoracotomy from 2013 to 2021 in our institution. RESULTS The median patient age was 82 (81-83) years, and the median EuroSCORE II was 3.1% (2.3-4.9). A total of 19 (50%) patients underwent mitral valve repair. The median cardiopulmonary bypass duration was 78 (54-100) min and the median aortic cross-clamping duration was 57 (40-70) min. Two (5.3%) patients were converted to sternotomy, 1 (2.6%) underwent renal replacement therapy, 5 (13.2%) underwent reexploration for bleeding or tamponade, and 12 (31.6%) underwent permanent pacemaker implantation. The surgical repair success rate was 89.5%, with 2 (10.5%) patients requiring reoperation due to repair failure. No other patients required reoperation on the mitral valve. The median intensive care unit stay was 1 (1-2) day, and the median postoperative stay was 9.5 (8-14) days. There was no perioperative stroke or death. CONCLUSION Despite a relatively increased risk of pacemaker implantation and reexploration for bleeding, our data support the feasibility of mitral valve surgery via a right mini-thoracotomy in octogenarians, with short ischemic times, low overall in-hospital morbidity, and no mortality. Preferring replacement in mitral diseases with a high risk for repair failure could minimize reoperations in this high-risk subgroup.
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Affiliation(s)
- Vasileios Ntinopoulos
- Department of Cardiac Surgery, City Hospital of Zurich - Site Triemli, Zurich, Switzerland
| | | | - Nestoras Papadopoulos
- Department of Cardiac Surgery, City Hospital of Zurich - Site Triemli, Zurich, Switzerland
| | - Stak Dushaj
- Department of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Achim Haeussler
- Department of Cardiac Surgery, City Hospital of Zurich - Site Triemli, Zurich, Switzerland
- Department of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Omer Dzemali
- Department of Cardiac Surgery, City Hospital of Zurich - Site Triemli, Zurich, Switzerland
- Department of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland
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Squiccimarro E, Margari V, Kounakis G, Visicchio G, Pascarella C, Rotunno C, Carbone C, Paparella D. Mid-term results of endoscopic mitral valve repair and insights in surgical techniques for isolated posterior prolapse. J Cardiothorac Surg 2023; 18:248. [PMID: 37596680 PMCID: PMC10439628 DOI: 10.1186/s13019-023-02352-9] [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: 12/20/2022] [Accepted: 08/09/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND The adoption of minimally invasive techniques to perform mitral valve repair surgery is increasing. This is enhanced by the compelling evidence of satisfactory short-term results and lower major morbidity. We analyzed mid-term follow-up results of our experience, and further compared two techniques: isolated leaflet resection and neochord implantation for posterior leaflet prolapse. METHODS Data for all consecutive endoscopic mitral valve repairs via video-assisted right anterior mini-thoracotomy were analyzed between December 2012 and September 2021. The early and mid-term follow-up results were ascertained. The main outcome was the incidence of mortality and the recurrence of significant mitral regurgitation during follow-up which were summarized by the Kaplan-Meier estimator and compared between treatment arms using the stratified log-rank test. Secondary outcomes were the early-postoperative results including 30-days mortality and the occurrence of major complications. RESULTS A total of 309 patients were included. Along with ring annuloplasty, 136 (44.4%) patients received posterior leaflet resection (122 isolated) whereas 97 (31.1%) underwent posterior leaflet chords implantation (88 isolated). Forty-nine patients had annuloplasty alone. In-hospital mortality was 1.0%. Mean follow-up was 28.8 ± 22.0 months (maximum 8.3 years). Kaplan-Meier survival rate at 5 years was 97.3 ± 1.0%, mitral regurgitation ([Formula: see text]3+) or valve reoperation free-survival at 5 years was estimated as 94.5 ± 2.3%. Subgroup time-to-event analysis for the indexed outcomes showed no statistical significance between the techniques. CONCLUSIONS Endoscopic mitral valve repair is safe and associated with excellent short- and mid-term outcomes. No differences were found between leaflet resection and gore-tex chords implantation for posterior leaflet prolapse.
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Affiliation(s)
- Enrico Squiccimarro
- Division of Cardiac Surgery, Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto Luigi, 251, Foggia, 71122, Foggia, Italy
- Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Vito Margari
- Division of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, Bari, Italy
| | - Georgios Kounakis
- Division of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, Bari, Italy
| | - Giuseppe Visicchio
- Division of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, Bari, Italy
| | - Clemente Pascarella
- Division of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, Bari, Italy
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Crescenzia Rotunno
- Division of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, Bari, Italy
| | - Carmine Carbone
- Division of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, Bari, Italy
| | - Domenico Paparella
- Division of Cardiac Surgery, Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto Luigi, 251, Foggia, 71122, Foggia, Italy.
- Division of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, Bari, Italy.
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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.
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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.
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Grazioli V, Giroletti L, Graniero A, Albano G, Mazzoni M, Panisi PG, Gerometta P, Anselmi A, Agnino A. Comparative myocardial protection of endoaortic balloon versus external clamp in minimally invasive mitral valve surgery. J Cardiovasc Med (Hagerstown) 2023; 24:184-190. [PMID: 36409631 DOI: 10.2459/jcm.0000000000001404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
AIMS Minimally invasive mitral valve surgery leads to shorter postoperative recovery time, cosmetic advantages and significant pain reduction compared with the standard sternotomy approach. Both an external aortic clamp and an endoaortic balloon occlusion can be used to manage the ascending aorta and the myocardial protection. In this study, we aimed to compare these two strategies in terms of effectiveness of myocardial protection and associated early postoperative outcomes. METHODS We investigated the retrospective records of prospectively collected data of patients treated by minimally invasive mitral valve surgery from March 2014 to June 2019. A total of 180 cases (78 in the external aortic clamp group and 102 in the endoaortic balloon clamp group) were collected. A propensity weighting analysis was adopted to adjust for baseline variables. RESULTS The endoaortic balloon clamp presented higher EuroSCORE II (higher reoperative surgery rate). The intra- and postoperative data were similar between the two groups: the postoperative troponin-I levels, peak of serum lactates and rate of myocardial infarction were also comparable. The endoaortic clamp group recorded longer operative, cardiopulmonary bypass and cross-clamp times. The external clamp group showed a higher rate of postoperative atrial fibrillation and conduction block. CONCLUSIONS In experienced centers, the use of the endoaortic balloon clamp is safe, reproducible and comparable to the external aortic clamp regarding the effectiveness of myocardial protection: its employment might facilitate minimally invasive mitral valve surgery.
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Affiliation(s)
| | - Laura Giroletti
- Cardiovascular Surgery Department
- Division of Robotic and Minimally Invasive Cardiac Surgery
| | - Ascanio Graniero
- Cardiovascular Surgery Department
- Division of Robotic and Minimally Invasive Cardiac Surgery
| | - Giovanni Albano
- Division of Cardiac Anesthesia, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | - Maurizio Mazzoni
- Division of Cardiac Anesthesia, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | | | | | - Amedeo Anselmi
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
| | - Alfonso Agnino
- Cardiovascular Surgery Department
- Division of Robotic and Minimally Invasive Cardiac Surgery
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El-Andari R, Fialka NM, Nagendran J. Enhanced recovery after cardiac surgery: The next step towards optimized care. Int J Cardiol 2023; 372:48-49. [PMID: 36493928 DOI: 10.1016/j.ijcard.2022.12.012] [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: 11/29/2022] [Accepted: 12/04/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Ryaan El-Andari
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada.
| | - Nicholas M Fialka
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Jeevan Nagendran
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada.
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Södergren A, Solbritt Rantapää-Dahlqvist, Ljung L. Time Trends of Cardiovascular Disease in the General Population and Inflammatory Arthritis. Rheum Dis Clin North Am 2023; 49:1-17. [PMID: 36424020 DOI: 10.1016/j.rdc.2022.07.003] [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: 11/22/2022]
Abstract
Cardiovascular diseases (CVDs) are the leading causes of death in the world, but declining trends for cardiovascular (CV) mortality and morbidity have been observed during the last decades. Reports on secular trends regarding the excess CV mortality and morbidity in rheumatoid arthritis show diverging results. Data support that also patients with inflammatory arthritis have benefited from improved treatment and prevention for CVD, which can be observed, for example, in decreased case fatality after CV event. However, several recent studies indicate a remaining excess CV risk in patients with inflammatory arthritis.
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Affiliation(s)
- Anna Södergren
- Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, 901 87 Umeå, Sweden; Wallenberg Centre for Molecular Medicine (WCMM), Umeå University, Umeå, Sweden.
| | | | - Lotta Ljung
- Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, 901 87 Umeå, Sweden; Center for Rheumatology, Academic Specialist Center, Stockholm Health Services, Box 6357, Stockholm 102 35, Sweden. https://twitter.com/lotta_ljung
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10
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Castillo-Sang M. Endoscopic Mitral Surgery in Cardiogenic Shock. ENDOSCOPIC CARDIAC SURGERY 2023:255-275. [DOI: 10.1007/978-3-031-21104-1_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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11
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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.
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Réhabilitation améliorée après chirurgie cardiaque adulte sous CEC ou à cœur battant 2021. ANESTHÉSIE & RÉANIMATION 2022. [DOI: 10.1016/j.anrea.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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13
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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.
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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
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14
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Mertes PM, Kindo M, Amour J, Baufreton C, Camilleri L, Caus T, Chatel D, Cholley B, Curtil A, Grimaud JP, Houel R, Kattou F, Fellahi JL, Guidon C, Guinot PG, Lebreton G, Marguerite S, Ouattara A, Provenchère Fruithiot S, Rozec B, Verhoye JP, Vincentelli A, Charbonneau H. Guidelines on enhanced recovery after cardiac surgery under cardiopulmonary bypass or off-pump. Anaesth Crit Care Pain Med 2022; 41:101059. [PMID: 35504126 DOI: 10.1016/j.accpm.2022.101059] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To provide recommendations for enhanced recovery after cardiac surgery (ERACS) based on a multimodal perioperative medicine approach in adult cardiac surgery patients with the aim of improving patient satisfaction, reducing postoperative mortality and morbidity, and reducing the length of hospital stay. DESIGN A consensus committee of 20 experts from the French Society of Anaesthesia and Intensive Care Medicine (Société française d'anesthésie et de réanimation, SFAR) and the French Society of Thoracic and Cardiovascular Surgery (Société française de chirurgie thoracique et cardio-vasculaire, SFCTCV) was convened. A formal conflict-of-interest policy was developed at the onset of the process and enforced throughout. The entire guideline process was conducted independently of any industry funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide the assessment of the quality of evidence. METHODS Six fields were defined: (1) selection of the patient pathway and its information; (2) preoperative management and rehabilitation; (3) anaesthesia and analgesia for cardiac surgery; (4) surgical strategy for cardiac surgery and bypass management; (5) patient blood management; and (6) postoperative enhanced recovery. For each field, the objective of the recommendations was to answer questions formulated according to the PICO model (Population, Intervention, Comparison, Outcome). Based on these questions, an extensive bibliographic search was carried out and analyses were performed using the GRADE approach. The recommendations were formulated according to the GRADE methodology and then voted on by all the experts according to the GRADE grid method. RESULTS The SFAR/SFCTCV guideline panel provided 33 recommendations on the management of patients undergoing cardiac surgery under cardiopulmonary bypass or off-pump. After three rounds of voting and several amendments, a strong agreement was reached for the 33 recommendations. Of these recommendations, 10 have a high level of evidence (7 GRADE 1+ and 3 GRADE 1-); 19 have a moderate level of evidence (15 GRADE 2+ and 4 GRADE 2-); and 4 are expert opinions. Finally, no recommendations were provided for 3 questions. CONCLUSIONS Strong agreement existed among the experts to provide recommendations to optimise the complete perioperative management of patients undergoing cardiac surgery.
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Affiliation(s)
- Paul-Michel Mertes
- Department of Anaesthesia and Intensive Care, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, FMTS de Strasbourg, Strasbourg, France
| | - Michel Kindo
- Department of Cardiac Surgery, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, FMTS de Strasbourg, Strasbourg, France
| | - Julien Amour
- Institut de Perfusion, de Réanimation, d'Anesthésie de Chirurgie Cardiaque Paris Sud, IPRA, Hôpital Privé Jacques Cartier, Massy, France
| | - Christophe Baufreton
- Department of Cardiovascular and Thoracic Surgery, University Hospital, Angers, France; MITOVASC Institute CNRS UMR 6214, INSERM U1083, University, Angers, France
| | - Lionel Camilleri
- Department of Cardiovascular Surgery, CHU Clermont-Ferrand, T.G.I, I.P., CNRS, SIGMA, UCA, UMR 6602, Clermont-Ferrand, France
| | - Thierry Caus
- Department of Cardiac Surgery, UPJV, Amiens University Hospital, Amiens Picardy University Hospital, Amiens, France
| | - Didier Chatel
- Department of Cardiac Surgery (D.C.), Institut du Coeur Saint-Gatien, Nouvelle Clinique Tours Plus, Tours, France
| | - Bernard Cholley
- Anaesthesiology and Intensive Care Medicine, Hôpital Européen Georges-Pompidou, AP-HP, Université de Paris, INSERM, IThEM, Paris, France
| | - Alain Curtil
- Department of Cardiac Surgery, Clinique de la Sauvegarde, Lyon, France
| | | | - Rémi Houel
- Department of Cardiac Surgery, Saint Joseph Hospital, Marseille, France
| | - Fehmi Kattou
- Department of Anaesthesia and Intensive Care, Institut Mutualiste Montsouris, Paris, France
| | - Jean-Luc Fellahi
- Service d'Anesthésie-Réanimation, Hôpital Universitaire Louis Pradel, Hospices Civils de Lyon, Lyon, France; Faculté de Médecine Lyon Est, Université Claude-Bernard Lyon 1, Lyon, France
| | - Catherine Guidon
- Department of Anaesthesiology and Critical Care Medicine, University Hospital Timone, Aix Marseille University, Marseille, France
| | - Pierre-Grégoire Guinot
- Department of Anaesthesiology and Intensive Care, Dijon University Hospital, Dijon, France; University of Bourgogne and Franche-Comté, LNC UMR1231, Dijon, France; INSERM, LNC UMR1231, Dijon, France; FCS Bourgogne-Franche Comté, LipSTIC LabEx, Dijon, France
| | - Guillaume Lebreton
- Sorbonne Université, INSERM, Unité mixte de recherche CardioMetabolisme et Nutrition, ICAN, AP-HP, Hôpital Pitié-Salpétrière, Paris, France
| | - Sandrine Marguerite
- Department of Anaesthesia and Intensive Care, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, FMTS de Strasbourg, Strasbourg, France
| | - Alexandre Ouattara
- CHU Bordeaux, Department of Anaesthesia and Critical Care, Magellan Medico-Surgical Centre, F-33000 Bordeaux, France; Univ. Bordeaux, INSERM, UMR 1034, Biology of Cardiovascular Diseases, F-33600 Pessac, France
| | - Sophie Provenchère Fruithiot
- Department of Anaesthesia, Université de Paris, Bichat-Claude Bernard Hospital, Paris, France; Centre d'Investigation Clinique 1425, INSERM, Université de Paris, Paris, France
| | - Bertrand Rozec
- Service d'Anesthésie-Réanimation, Hôpital Laennec, CHU Nantes, Nantes, France; Université de Nantes, CHU Nantes, CNRS, INSERM, Institut duDu Thorax, Nantes, France
| | - Jean-Philippe Verhoye
- Department of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
| | - André Vincentelli
- Department of Cardiac Surgery, University of Lille, CHU Lille, Lille, France
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15
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Squiccimarro E, Margari V, Paparella D. Bilateral mini-thoracotomy for combined minimally invasive direct coronary artery bypass and mitral valve repair. Eur J Cardiothorac Surg 2022; 62:6584819. [PMID: 35552396 DOI: 10.1093/ejcts/ezac306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/14/2022] [Accepted: 05/05/2022] [Indexed: 11/14/2022] Open
Abstract
Consistent evidence recognizes minimally invasive valve surgery as the top-tier surgical approach for heart valve pathology. Conversely, the overall adoption of minimally invasive coronary surgery remains low. Notwithstanding, excellent clinical outcomes have been recently reported, further consolidating a technique that addresses major concerns associated with the traditional approach for the most frequently performed cardiac operation, including sternal dehiscence (i.e., sternal sparing), stroke (i.e., no-touch aorta), but that also guarantees a reduced resort to blood transfusions, diminished pain, and faster recovery. More to the point, the suitability of minimally invasive strategies for combined coronary and valve procedures remains debatable. Almost no reports of such combined procedures are available in literature and the very few published experiences appear scarce and heterogeneous about the surgical access (i.e., single versus bilateral mini-thoracotomy). However, bilateral mini-thoracotomy has been proposed as a feasible and safe strategy for different cardiac operations like surgical ablation and left ventricular assist device implantation, but also for isolated multivessel minimally invasive coronary surgery. Here we describe feasibility of combined minimally invasive mitral valve and coronary surgery performed through bilateral mini-thoracotomy and we report outcomes of our initial series of 3 cases.
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Affiliation(s)
- Enrico Squiccimarro
- Division of Cardiac Surgery, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.,Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Vito Margari
- Division of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, Bari, Italy
| | - Domenico Paparella
- Division of Cardiac Surgery, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.,Division of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, Bari, Italy
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16
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Moscarelli M, Lorusso R, Angelini GD, Di Bari N, Paparella D, Fattouch K, Albertini A, Nasso G, Fiorentino F, Speziale G. Sex-specific differences and postoperative outcomes of minimally invasive and sternotomy valve surgery. Eur J Cardiothorac Surg 2022; 61:695-702. [PMID: 34392335 PMCID: PMC8858592 DOI: 10.1093/ejcts/ezab369] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 07/02/2021] [Accepted: 07/08/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Female sex is an established risk factor for postoperative complications after heart surgery, but the influence of sex on outcomes after minimally invasive cardiac surgery (MICS) for valvular replacement/repair remains controversial. We examined whether the role of sex as a risk factor varies by surgical approach [MICS vs conventional sternotomy (ST)] and further assessed outcomes among female patients including in-hospital mortality and postoperative complications by surgical approach. METHODS We analysed data from a multicentre registry for patients who underwent isolated aortic valve and mitral surgery with MICS or ST. The primary outcome was in-hospital mortality. Propensity score matching was used to minimize between-group differences. RESULTS Among the 15 155 patients included in the study, 7674 underwent MICS (50.6%). Female sex was equally distributed in the MICS and ST groups (47.3% vs 47.6%, respectively). Risk for surgery was higher in the ST group than in the MICS group {EuroSCORE II: 4.0 [standard deviation (SD): 6.8] vs 3.7 [SD: 6.4]; P = 0.005}, including among female patients only [ST vs MICS 4.6 (SD: 6.9) vs 4.2 (SD: 6.3); P = 0.04]. Mortality did not significantly vary by procedure among women [MICS vs ST, 2.4% vs 2.8%; hazard ratio 1.09, 95% confidence interval 0.71-1.73; P (surgical approach × sex) = 0.51]. The results also did not vary after adjusting for confounders. CONCLUSIONS Female sex was associated with higher mortality in patients undergoing valve surgery, regardless of surgical approach. In female patients, MICS did not provide any benefits over ST in terms of in-hospital deaths or postoperative complications. SUBJECT COLLECTION 117, 125.
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Affiliation(s)
- Marco Moscarelli
- Department of Cardiovascular Surgery, GVM Care & Research, Anthea Hospital, Bari, Italy
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Gianni D Angelini
- Department of Cardiovascular Surgery, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Nicola Di Bari
- Department of Cardiovascular Surgery, GVM Care & Research, Anthea Hospital, Bari, Italy
| | - Domenico Paparella
- Department of Cardiovascular Surgery, GVM Care & Research, Santa Maria Hospital, Bari, Italy
| | - Khalil Fattouch
- Department of Cardiovascular Surgery, GVM Care & Research, Maria Eleonora Hospital, Palermo, Italy
| | - Alberto Albertini
- Department of Cardiovascular Surgery, GVM Care & Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Giuseppe Nasso
- Department of Cardiovascular Surgery, GVM Care & Research, Anthea Hospital, Bari, Italy
| | - Francesca Fiorentino
- Department of Surgery and Cancer and Imperial Clinical Trials Unit, Imperial College London, London, UK
| | - Giuseppe Speziale
- Department of Cardiovascular Surgery, GVM Care & Research, Anthea Hospital, Bari, Italy
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17
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OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6555288. [DOI: 10.1093/ejcts/ezac167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 02/15/2022] [Accepted: 02/25/2022] [Indexed: 11/14/2022] Open
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18
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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.
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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
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19
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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.
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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
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20
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Barbero C, Rinaldi M, Marchetto G, Valentini MC, Cura Stura E, Bosco G, Pocar M, Filippini C, Boffini M, Ricci D. Magnetic Resonance Imaging for Cerebral Micro-embolizations During Minimally Invasive Mitral Valve Surgery. J Cardiovasc Transl Res 2021; 15:828-833. [PMID: 34845626 DOI: 10.1007/s12265-021-10188-8] [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: 04/08/2021] [Accepted: 11/11/2021] [Indexed: 10/19/2022]
Abstract
The role of aortic clamping techniques on the occurrence of neurological complications after right mini-thoracotomy mitral valve surgery is still debated. Brain injuries can occur also as silent cerebral micro-embolizations (SCM), which have been linked to significant deficits in physical and cognitive functions. Aims of this study are to evaluate the overall rate of SCM and to compare endoaortic clamp (EAC) with trans-thoracic clamp (TTC). Patients enrolled underwent a pre-operative, a post-operative, and a follow-up MRI. Forty-three patients were enrolled; EAC was adopted in 21 patients, TTC in 22 patients. Post-operative SCM were reported in 12 cases (27.9%). No differences between the 2 groups were highlighted (23.8% SCM in the EAC group versus 31.8% in the TTC). MRI analysis showed post-operative SCM in nearly 30% of selected patients after right mini-thoracotomy mitral valve surgery. Subgroup analysis on different types of aortic clamping showed comparable results. CLINICAL RELEVANCE: The rate of SCM reported in the present study on patients undergoing minimally invasive MVS and RAP is consistent with data in the literature on patients undergoing cardiac surgery through median sternotomy and antegrade arterial perfusion. Moreover, no differences were reported between EAC and TTC: both the aortic clamping techniques are safe, and the choice of the surgical setting to adopt can be really done according to the patient's characteristics.
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Affiliation(s)
- Cristina Barbero
- Department of Cardiovascular and Thoracic Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy.
| | - Mauro Rinaldi
- Department of Cardiovascular and Thoracic Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Giovanni Marchetto
- Department of Cardiovascular and Thoracic Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Maria Consuelo Valentini
- Department of Neuroradiology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Erik Cura Stura
- Department of Cardiovascular and Thoracic Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Giovanni Bosco
- Department of Neurology, Città Della Salute E Della Scienza, University of Turin, Turin, Italy
| | - Marco Pocar
- Department of Cardiovascular and Thoracic Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Claudia Filippini
- Department of Anesthesia and Critical Care, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Massimo Boffini
- Department of Cardiovascular and Thoracic Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Davide Ricci
- Cardiac Surgery Unit, IRCCS Policlinic Hospital San Martino, Genova, Italy
- Department of Integrated Surgical and Diagnostic Sciences, University of Genova, Genova, Italy
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21
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Persistent and acute postoperative pain after cardiac surgery with anterolateral thoracotomy or median sternotomy: A prospective observational study. J Clin Anesth 2021; 77:110577. [PMID: 34799229 DOI: 10.1016/j.jclinane.2021.110577] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The primary objective of this study was to compare the association between cardiac surgical approach (thoracotomy vs. sternotomy) and incidence of persistent postoperative pain at 3 months. Secondary objectives were the incidence and intensity of persistent pain at 6 and 12 months, acute postoperative pain, analgesic requirement and its side effects. DESIGN Single-center, prospective, observational study. Recruitment between December 2017 and August 2018. SETTING Perioperative care at university-affiliated tertiary care centre. PATIENTS 202 adults scheduled for cardiac surgery. Patients with chronic pain or behavioural disorder were excluded. INTERVENTIONS Thoracotomy (n = 106) and sternotomy (n = 96). MEASUREMENTS Pain scores and pain medication requirements from extubation until hospital discharge. Persistent postoperative pain was assessed using a telephone questionnaire. MAIN RESULTS Incidence and intensity of pain was not significantly different between thoracotomy or sternotomy either in the short- or in the long-term follow-up. Incidence of persistent postoperative pain showed no differences between groups (30.2 vs 22.9% at 3 months (p = 0.297), 10.4 vs 7.3% at 6 months (p = 0.364) and 7.5 vs 7.3% at 12 months (p = 0.518) in thoracotomy and sternotomy group). A significant decrease of pain incidence was observed between 3 and 6 months (p < 0.001) but not between 6 and 12 months (p = 0.259) in both groups. ANOVA of repeated measures adjusted for confounding variable showed a decrease of acute pain intensity over time (p = 0.001) with no difference between groups (p = 0.145). Acute pain medication requirements were not different between the groups (p = 0.237 for piritramide and p = 0.743 for oxycodone) with no difference in their side effects. CONCLUSIONS Our study showed no difference in short- or long-term pain in patients undergoing anterolateral thoracotomy or median sternotomy. Both groups showed a decrease in persistent postoperative pain incidence between 3 and 6 months without any significant changes at 12 months.
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22
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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.
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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
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Maranta F, Cianfanelli L, Grippo R, Alfieri O, Cianflone D, Imazio M. Post-pericardiotomy syndrome: insights into neglected postoperative issues. Eur J Cardiothorac Surg 2021; 61:505-514. [PMID: 34672331 DOI: 10.1093/ejcts/ezab449] [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: 01/26/2021] [Revised: 07/01/2021] [Accepted: 07/27/2021] [Indexed: 12/20/2022] Open
Abstract
ABSTRACT OBJECTIVES Pericardial effusion is a common complication after cardiac surgery, both isolated and in post-pericardiotomy syndrome (PPS), a condition in which pleuropericardial damage triggers both a local and a systemic inflammatory/immune response. The goal of this review was to present a complete picture of PPS and pericardial complications after cardiac surgery, highlighting available evidence and gaps in knowledge. METHODS A literature review was performed that included relevant prospective and retrospective studies on the subject. RESULTS PPS occurs frequently and is associated with elevated morbidity and significantly increased hospital stays and costs. Nevertheless, PPS is often underestimated in clinical practice, and knowledge of its pathogenesis and epidemiology is limited. Several anti-inflammatory drugs have been investigated for treatment but with conflicting evidence. Colchicine demonstrated encouraging results for prevention. CONCLUSIONS Wider adoption of standardized diagnostic criteria to correctly define PPS and start early treatment is needed. Larger studies are necessary to better identify high-risk patients who might benefit from preventive strategies.
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Affiliation(s)
- Francesco Maranta
- Cardiac Rehabilitation Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Cianfanelli
- Cardiac Rehabilitation Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Rocco Grippo
- Cardiac Rehabilitation Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Ottavio Alfieri
- Cardiac Surgery Department, San Raffaele Scientific Institute, Milan, Italy
| | - Domenico Cianflone
- Cardiac Rehabilitation Unit, San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Imazio
- Cardiology, Cardiothoracic Department, University Hospital "Santa Maria della Misericordia", Udine, Italy
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24
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Huang W, Hou B, Li Q, Zhang Y, Wang L. Comparative efficacy of five surgical methods in the treatment of mitral regurgitation: A systematic review and network meta-analysis. J Card Surg 2021; 37:186-196. [PMID: 34662452 DOI: 10.1111/jocs.16085] [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: 08/20/2021] [Revised: 09/19/2021] [Accepted: 10/08/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study has been compared the effectiveness of different surgical methods in the treatment of mitral regurgitation (MR) in adults by using the network meta-analysis method, so as to provide reference for clinical selection of the best surgical scheme. METHODS The PubMed, EMBASE, the Cochrane Library, CNKI, and Chongqing VIP Information databases were comprehensively searched until December 2020. We collected retrospective comparative studies on surgical procedures including 3D endoscopic mitral valve surgery (3D-MVS), robot-assisted mitral valve surgery (R-MVS); totally thoracoscopic mitral valve surgery (T-MVS), small incision mitral valve surgery (M-MVS), and traditional thoracotomy mitral valve surgery (C-MVS). Stata16.0 and Addis1.16.8 software was used for network meta-analysis using the Bayesian approach. RESULTS A total of 31 studies were included, 12,998 patients, involving five surgical methods. Network meta-analysis showed that: in terms of complications (odds ratio [OR]: 0.65, 95% CI: 0.13-3.00, probability rank = 0.37) and MR (OR: 0.03, 95% CI: 0.0-8315, probability rank = 0.64), the 3D-MVS group had the lowest event rate. In terms of blood transfusion rate (OR: 0.55, 95% CI: 0.16-1.84, probability rank = 0.45), T-MVS had the lowest event rate. In addition, with the exception of operation time and chest drainage, the R-MVS group has the best curative effect. CONCLUSION This minimally invasive surgery has their own advantages and disadvantages. Overall, 3D-MVS is most satisfactory, but more samples are needed.
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Affiliation(s)
- Weimin Huang
- Baotou Clinical Medical College of Inner Mongolia Medical University, Baotou, China
| | - Biao Hou
- Baotou Clinical Medical College of Inner Mongolia Medical University, Baotou, China
| | - Qin Li
- Baotou Clinical Medical College of Inner Mongolia Medical University, Baotou, China
| | - Yuhai Zhang
- Baotou Clinical Medical College of Inner Mongolia Medical University, Baotou, China
| | - Liang Wang
- Department of Cardiology, Baotou Central Hospital, Baotou, China
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25
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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.
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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
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26
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Paparella D. New goals for coronary surgery: the road is difficult, but the path is clear. Eur J Cardiothorac Surg 2021; 61:447-448. [PMID: 34652435 DOI: 10.1093/ejcts/ezab453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 08/28/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Domenico Paparella
- Santa Maria Hospital, Department of Cardiac Surgery., GVM Care & Research, Bari, Italy.,Dipartimento Scienze Mediche e Chirurgiche, Università di Foggia, Foggia, Italy
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27
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Pojar M, Karalko M, Dergel M, Vojacek J. Minimally invasive or sternotomy approach in mitral valve surgery: a propensity-matched comparison. J Cardiothorac Surg 2021; 16:228. [PMID: 34376231 PMCID: PMC8353832 DOI: 10.1186/s13019-021-01578-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 07/09/2021] [Indexed: 12/30/2022] Open
Abstract
Objectives Conventional mitral valve surgery through median sternotomy improves long-term survival with acceptable morbidity and mortality. However, less-invasive approaches to mitral valve surgery are now increasingly employed. Whether minimally invasive mitral valve surgery is superior to conventional surgery is uncertain. Methods A retrospective analysis of patients who underwent mitral valve surgery via minithoracotomy or median sternotomy between 2012 and 2018. A propensity score-matched analysis was generated to eliminate differences in relevant preoperative risk factors between the two groups. Results Data from 525 patients were evaluated, 189 underwent minithoracotomy and 336 underwent median sternotomy. The 30 day mortality was similar between the minithoracotomy and conventional surgery groups (1 and 3%, respectively; p = 0.25). No differences were seen in the incidence of stroke (p = 1.00), surgical site infections (p = 0.09), or myocardial infarction (p = 0.23), or in total hospital cost (p = 0.48). However, the minimally invasive approach was associated with fewer patients receiving transfusions (59% versus 76% in the conventional group; p = 0.001) or requiring reoperation for bleeding (3% versus 9%, respectively; p = 0.03). There were no significant differences in 5 year survival between the minithoracotomy and conventional surgery groups (93% versus 86%, respectively; p = 0.21) and freedom from mitral valve reoperation (95% versus 94%, respectively; p = 0.79). Conclusions In patients undergoing mitral valve surgery, a minimally invasive approach is feasible, safe, and reproducible with excellent short-term outcomes; mid-term outcomes and efficacy were also seen to be comparable to conventional sternotomy.
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Affiliation(s)
- Marek Pojar
- Department of Cardiac Surgery, Faculty of Medicine in Hradec Kralove and University Hospital Hradec Kralove, Charles University, Sokolska 581, 500 05, Hradec Kralove, Czech Republic.
| | - Mikita Karalko
- Department of Cardiac Surgery, Faculty of Medicine in Hradec Kralove and University Hospital Hradec Kralove, Charles University, Sokolska 581, 500 05, Hradec Kralove, Czech Republic
| | - Martin Dergel
- Department of Cardiac Surgery, Faculty of Medicine in Hradec Kralove and University Hospital Hradec Kralove, Charles University, Sokolska 581, 500 05, Hradec Kralove, Czech Republic
| | - Jan Vojacek
- Department of Cardiac Surgery, Faculty of Medicine in Hradec Kralove and University Hospital Hradec Kralove, Charles University, Sokolska 581, 500 05, Hradec Kralove, Czech Republic
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28
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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.
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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
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29
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Alqahtani F, Kawsara A, Crestanello JA, Alkhouli M. Differences in the characteristics and outcomes of isolated tricuspid and mitral valve surgery for valvular regurgitation. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 36:14-17. [PMID: 34023248 DOI: 10.1016/j.carrev.2021.05.008] [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: 09/29/2020] [Revised: 05/08/2021] [Accepted: 05/11/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Isolated tricuspid valve (TV) surgery is associated with markedly worse outcomes than isolated mitral valve (MV) surgery. We hypothesized that this is related to late referral of patients with isolated TV disease. METHODS Adult patients who underwent isolated TV or MV surgery in 2016-2017 were identified in the National-Readmission-Database. We compared the outcomes of isolated TV and MV surgery before and after adjustment for surrogates of late referral. RESULTS A total of 21,446 patients who had isolated MV (n = 19,933), or TV surgery (n = 1153) were included. Patients in the TV group were younger (55.7 ± 16.6 vs. 63.4 ± 12.3 years), had lower socioeconomic status, but higher prevalence of surrogates for late referral [acute HF 41.0% vs. 22.0%, advanced liver disease 16.8% vs. 2.6%, non-elective surgery status 44.3% vs. 23.5%, need for peri-operative mechanical circulatory support 27.7% vs. 4.7%, and unplanned admissions in the 90 days before surgery 31.0% vs. 18.8%, (P < 0.001 for all)]. Surgery was performed on day 0/1 of the admission in 80% of patients in the MV group and 52% in the TV group, P < 0.001. Repair rate was 63.5% in the TV group and 56.3% in the MV group (P < 0.001). In-hospital mortality was 3-folds higher after TV surgery (8.7% vs. 2.5%; OR = 3.41, 95%CI 2.73-4.25, p < 0.001). However, this difference became non-significant after adjusting for baseline characteristics including surrogates for late referral (OR = 1.24, 95%CI 0.85-1.82, p = 0.27). CONCLUSION The poor outcomes of isolated TV surgery compared with isolated MV surgery may be largely explained by the late referral for intervention in patients with isolated TR.
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Affiliation(s)
- Fahad Alqahtani
- Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, MN, United States of America
| | - Akram Kawsara
- Division of Cardiology, Department of Medicine, West Virginia University, Morgantown, WV, United States of America
| | - Juan A Crestanello
- Department of Cardiovascular Surgery, Mayo Clinic School of Medicine, Rochester, MN, United States of America
| | - Mohamad Alkhouli
- Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, MN, United States of America.
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30
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Coutinho GF, Antunes MJ. Current status of the treatment of degenerative mitral valve regurgitation. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2021. [DOI: 10.1016/j.repce.2020.10.019] [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] Open
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31
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Coutinho GF, Antunes MJ. Current status of the treatment of degenerative mitral valve regurgitation. Rev Port Cardiol 2021; 40:293-304. [PMID: 33745777 DOI: 10.1016/j.repc.2020.10.011] [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: 08/12/2020] [Revised: 10/04/2020] [Accepted: 10/08/2020] [Indexed: 11/29/2022] Open
Abstract
Degenerative mitral valve disease (myxomatous degeneration or fibroelastic deficiency) is the most common indication for surgical referral to treat mitral regurgitation. Mitral valve repair is the procedure of choice whenever feasible and when the results are expected to be durable. Posterior leaflet prolapse is the commonest lesion, found in up to two-thirds of patients. It is the easiest to repair, particularly when limited to one segment. In these cases, rates of repairability and procedural success approach 100%, and there is now ample evidence that the immediate and long-term results are better than those of valve replacement. Notably, minimally invasive valvular procedures, surgical or interventional, have attracted increasing interest in the last decade. When performed by experienced groups, mitral valve repair is unrivaled irrespective of the severity of lesions, from simple to complex, which leaflets are involved, and the type of degenerative involvement (myxomatous or fibroelastic). Its results should be viewed as the benchmark for other present and future technologies. By contrast, percutaneous mitral valve repair is still in its infancy and its results so far fall short of those of surgical repair. Nevertheless, continued investment in transcatheter procedures is of great importance to enable development and improved accessibility, particularly for patients who are considered unsuitable for surgery. In this review, we analyze the current status of management of degenerative mitral valve disease, discussing mitral valve anatomy and pathology, indications for intervention, and current surgical and transcatheter mitral valve procedures and results.
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Affiliation(s)
- Gonçalo F Coutinho
- Cardiothoracic Surgery Department, University Hospital and Center of Coimbra, Coimbra, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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32
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Voetsch A, Winkler A, Krombholz-Reindl P, Neuner M, Kirnbauer M, Seitelberger R, Gottardi R. Lower hemisternotomy: infrequently used but versatile. THE JOURNAL OF CARDIOVASCULAR SURGERY 2021; 62:496-501. [PMID: 33616351 DOI: 10.23736/s0021-9509.21.11670-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND A lower hemisternotomy is an infrequently used approach in cardiac surgery. This single center report evaluates applicability and clinical outcomes of procedures performed through a lower hemisternotomy. METHODS The institutional database was reviewed. From 2014 to 2019, 55 consecutive patients had undergone minimally invasive procedures through a lower hemisternotomy (median follow-up 34 months). Demographic as well as outcome data were retrieved from our prospectively maintained institutional database. RESULTS Performed procedures included mitral and tricuspid repairs, aortic valve replacement as well as coronary artery bypass grafting. The median patient age was 72 years. Out of the 55 patients, 55% were male. Predominantly mitral valve procedures (11 isolated, 30 combined) had been performed. Mitral valve procedures (n=41) consisted of 36 repairs and 5 replacements. Repair rate for degenerative mitral insufficiency was 97.6%. Median EuroScore II was 3.4 % [2.1-6.0]. Median cross-clamp time was 67 [44-99] min. Median procedural length was 169 [138-201] min. Reoperation rate for bleeding was 1.8%. Major vascular complications occurred in two patients. Freedom from valve related reoperation was 96.1% during follow-up. 30-day mortality and overall mortality during follow-up was 3.6% and 10.9%. CONCLUSIONS In properly selected cases the lower hemisternotomy allows for a variety of cardiac procedures. It permits central aortic cannulation and a direct vision of intracardiac structures and therefore should be kept in mind as an alternative minimally invasive approach.
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Affiliation(s)
- Andreas Voetsch
- Department of Cardiovascular and Endovascular Surgery, Paracelsus Private Medical University Salzburg, Salzburg, Austria
| | - Andreas Winkler
- Department of Cardiovascular and Endovascular Surgery, Paracelsus Private Medical University Salzburg, Salzburg, Austria
| | - Philipp Krombholz-Reindl
- Department of Cardiovascular and Endovascular Surgery, Paracelsus Private Medical University Salzburg, Salzburg, Austria
| | - Matthias Neuner
- Department of Anesthesia and Intensive Care, Paracelsus Private Medical University Salzburg, Salzburg, Austria
| | - Michael Kirnbauer
- Department of Anesthesia and Intensive Care, Paracelsus Private Medical University Salzburg, Salzburg, Austria
| | - Rainald Seitelberger
- Department of Cardiovascular and Endovascular Surgery, Paracelsus Private Medical University Salzburg, Salzburg, Austria
| | - Roman Gottardi
- Department of Cardiovascular and Endovascular Surgery, Paracelsus Private Medical University Salzburg, Salzburg, Austria - .,Department of Cardiac, Thoracic and Vascular Surgery, Mediclin Heart Insitute Lahr/Baden, Lahr, Germany
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33
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Condello I, Mastroroberto P, Santarpino G. Early Surgery of the Mitral Valve: Do We Have "New" Predictor Factors? Ann Thorac Surg 2021; 112:1029. [PMID: 33497661 DOI: 10.1016/j.athoracsur.2020.10.081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 10/24/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Ignazio Condello
- GVM Care & Research, Perfusion Service, Anthea Hospital, Via Camillo Rosalba 35/37, 70124 Bari, Italy.
| | - Pasquale Mastroroberto
- Department of Experimental and Clinical Medicine, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Giuseppe Santarpino
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, Bari, Italy; Department of Experimental and Clinical Medicine, "Magna Graecia" University of Catanzaro, Catanzaro, Italy; Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany
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34
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Kawsara A, Alqahtani F, Nkomo VT, Eleid MF, Pislaru SV, Rihal CS, Nishimura RA, Schaff HV, Crestanello JA, Alkhouli M. Determinants of Morbidity and Mortality Associated With Isolated Tricuspid Valve Surgery. J Am Heart Assoc 2021; 10:e018417. [PMID: 33399012 PMCID: PMC7955319 DOI: 10.1161/jaha.120.018417] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background Whether the poor outcomes of isolated tricuspid valve surgery are related to the operation itself or to certain patient characteristics including late referral is unknown. Methods and Results Adult patients who underwent isolated tricuspid valve surgery were identified in the Nationwide Readmissions Database (2016–2017). Patients who had redo tricuspid valve surgery, endocarditis, or congenital heart disease were excluded. Multivariable logistic regression was performed to identify contributors to postoperative mortality. A total of 1513 patients were included (mean age 55.7±16.6 years, 49.6% women). Surrogates of late referral were frequent: 41% of patients were admitted with decompensated heart failure, 44.3% had a nonelective surgery status, 16.8% had advanced liver disease, and 31% had an unplanned hospitalization in the prior 90 days. The operation was performed on day 0 to 1 of the hospitalization in only 50% of patients, and beyond day 10 in 22% of patients. In‐hospital mortality occurred in 8.7% of patients. Median length of stay was 14 days (7–35 days), and median cost was $87 223 ($43 122–$200 872). In multivariable logistic regression analysis, surrogates for late referrals (acute heart failure decompensation, nonelective surgery status, or advanced liver disease) were the strongest predictors of in‐hospital mortality (odds ratio [OR], 4.75; 95% CI, 2.74–8.25 [P<0.001]). This was also consistent in a second model incorporating unplanned hospitalizations in the 90 days before surgery as a surrogate for late referral (OR, 5.50; 95% CI, 2.28–10.71 [P<0.001]). Conclusions The poor outcomes of isolated tricuspid valve surgery may be largely explained by the late referral for intervention. Studies are needed to determine the role of early intervention for severe isolated tricuspid regurgitation.
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Affiliation(s)
- Akram Kawsara
- Division of Cardiology Department of Medicine West Virginia University Morgantown WV
| | - Fahad Alqahtani
- Division of Cardiology Department of Medicine University of Kentucky Lexington KY
| | - Vuyisile T Nkomo
- Department of Cardiovascular Diseases Mayo Clinic School of Medicine Rochester MN
| | - Mackram F Eleid
- Department of Cardiovascular Diseases Mayo Clinic School of Medicine Rochester MN
| | - Sorin V Pislaru
- Department of Cardiovascular Diseases Mayo Clinic School of Medicine Rochester MN
| | - Charanjit S Rihal
- Department of Cardiovascular Diseases Mayo Clinic School of Medicine Rochester MN
| | - Rick A Nishimura
- Department of Cardiovascular Diseases Mayo Clinic School of Medicine Rochester MN
| | - Hartzell V Schaff
- Department of Cardiovascular Surgery Mayo Clinic School of Medicine Rochester MN
| | - Juan A Crestanello
- Department of Cardiovascular Surgery Mayo Clinic School of Medicine Rochester MN
| | - Mohamad Alkhouli
- Department of Cardiovascular Diseases Mayo Clinic School of Medicine Rochester MN
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35
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Margari V, Malvindi PG, De Santis A, Kounakis G, Visicchio G, Mastrototaro G, Dambruoso P, Carbone C, Paparella D. Minimally invasive tricuspid valve surgery without caval occlusion: Short and midterm results. J Card Surg 2021; 36:618-623. [PMID: 33403735 DOI: 10.1111/jocs.15278] [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: 10/08/2020] [Revised: 12/06/2020] [Accepted: 12/14/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The use of minimally invasive or transcatheter interventions rather than standard full sternotomy operations to treat tricuspid valve (TV) disease is increasing. The debate however is still open regarding venous drainage management during cardiopulmonary bypass (CPB) and wheatear or not superior and inferior vena cava should be occluded during the opening of the right atrium to avoid air entrance in the venous line. The aim of the present study is to report operative outcomes and midterm follow-up results of minimally invasive TV surgery performed without caval occlusion. METHODS A retrospective outcome evaluation from institutional records was performed with prospective data entry. Considered were consecutive patients who underwent right mini-thoracotomy TV surgery isolated or combined with mitral valve surgery during the period from June 2013 to February 2020. A telephone and echocardiographic follow-up was performed. RESULTS During the study period, 68 consecutive patients underwent minimally invasive TV surgery without occlusion of cava veins. The mean age was 69 ± 14 years and 48 (70%) were female. All operations were performed safely without air-lock during CPB. A perioperative cerebral stroke occurred in one patient. The survival at a 5- and 8-year follow-up was 100% and 79%, respectively. No severe tricuspid regurgitation was evident at echocardiographic follow-up. CONCLUSION Our results show that performing tricuspid surgery without caval occlusion is safe. The air was captured by the active vacuum drainage system without causing damage. Midterm follow-up data confirm that a minimally invasive approach does not alter the quality of surgery.
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Affiliation(s)
- Vito Margari
- Department of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, Bari, Italy
| | - Pietro G Malvindi
- Department of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, Bari, Italy
| | - Adriano De Santis
- Department of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, Bari, Italy
| | - Giorgio Kounakis
- Department of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, Bari, Italy
| | - Giuseppe Visicchio
- Department of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, Bari, Italy
| | - Giuseppe Mastrototaro
- Department of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, Bari, Italy
| | - Pierpaolo Dambruoso
- Department of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, Bari, Italy
| | - Carmine Carbone
- Department of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, Bari, Italy
| | - Domenico Paparella
- Department of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, Bari, Italy.,Dipartimento Scienze Mediche e Chirurgiche, Università di Foggia, Foggia, Italy
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36
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Ozcinar E. Minimal invasive approach in mitral valve surgery: Evolving method which requires higher experience and skills. Int J Cardiol 2020; 315:22-23. [PMID: 32311406 DOI: 10.1016/j.ijcard.2020.04.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/13/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Evren Ozcinar
- Department of Cardiovascular Surgery, Heart Center, Cebeci Hospitals, Ankara University School of Medicine, Ankara, Turkey.
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Sá MPBO, Van den Eynde J, Cavalcanti LRP, Kadyraliev B, Enginoev S, Zhigalov K, Ruhparwar A, Weymann A, Dreyfus G. Mitral valve repair with minimally invasive approaches vs sternotomy: A meta‐analysis of early and late results in randomized and matched observational studies. J Card Surg 2020; 35:2307-2323. [PMID: 32668091 DOI: 10.1111/jocs.14799] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Michel Pompeu B. O. Sá
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco, PROCAPEUniversity of Pernambuco Recife Pernambuco Brazil
| | - Jef Van den Eynde
- Department of Cardiovascular Diseases, Unit of Cardiac SurgeryUniversity Hospitals Leuven Leuven Belgium
| | - Luiz Rafael P. Cavalcanti
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco, PROCAPEUniversity of Pernambuco Recife Pernambuco Brazil
| | - Bakytbek Kadyraliev
- Department of Cardiac Surgery, S.G. Sukhanov Federal Center of Cardiovascular SurgeryE.A. Vagner Perm State Medical University Perm Russia
| | - Soslan Enginoev
- Department of Cardiac SurgeryFederal Center for Cardiovascular Surgery Astrakhan Russia
- Department of Cardiovascular SurgeryAstrakhan State Medical University Astrakhan Russia
| | - Konstantin Zhigalov
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center EssenUniversity Hospital of Essen, University Duisburg‐Essen Essen Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center EssenUniversity Hospital of Essen, University Duisburg‐Essen Essen Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center EssenUniversity Hospital of Essen, University Duisburg‐Essen Essen Germany
| | - Gilles Dreyfus
- Department of Cardiac Surgery, Institut MontsourisUniversity Pierre et Marie Curie Paris France
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38
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Calafiore AM, Totaro A, Testa N, Di Mauro M. Minimally invasive mitral valve repair: for every patient, for every surgeon or still a work in progress? J Thorac Dis 2020; 12:1621-1623. [PMID: 32395300 PMCID: PMC7212125 DOI: 10.21037/jtd.2020.02.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - Antonio Totaro
- Department of Cardiovascular Diseases, Gemelli Molise, Campobasso, Italy
| | - Nicola Testa
- Department of Cardiovascular Diseases, Gemelli Molise, Campobasso, Italy
| | - Michele Di Mauro
- Division of Cardiac Surgery, D'Annunzio University, Chieti, Italy
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