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Left Ventricular Assist Device Implantation via Lateral Thoracotomy: A Systematic Review and Meta-Analysis. J Heart Lung Transplant 2022; 41:1440-1458. [DOI: 10.1016/j.healun.2022.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 06/25/2022] [Accepted: 07/06/2022] [Indexed: 12/29/2022] Open
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Left Lateral Thoracotomy for Centrifugal Continuous-Flow Left Ventricular Assist Device Placement: An Analysis from the Mechanical Circulatory Support Research Network. ASAIO J 2018; 64:715-720. [DOI: 10.1097/mat.0000000000000714] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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van der Merwe J, Casselman F, Stockman B, Vermeulen Y, Degrieck I, Van Praet F. Late redo-port access surgery after port access surgery. Interact Cardiovasc Thorac Surg 2015; 22:13-8. [PMID: 26467637 DOI: 10.1093/icvts/ivv281] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 08/12/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study presents the first report on short- and long-term outcomes in redo-port access surgery after previous port access surgery (redo-PAS-PAS) for new or recurrent mitral valve (MV) and tricuspid valve (TV) disease. METHODS Our current surgical team performed redo-PAS-PAS in 26 consecutive patients who had previous port access surgery (mean age 65.8 ± 13.3 years, 46.2% female, 42.3% older than 70 years, mean logistical EuroSCORE 22.5 ± 21.6%) between 1 February 1997 and 30 June 2014. Surgical indications included among others MV prosthesis dysfunction (n = 8, 30.8%), endocarditis (n = 10, 38.5%) and TV dysfunction (n = 3, 11.5%). The mean time interval between primary PAS and redo-PAS-PAS was 70.32 ± 57.4 months. RESULTS Redo-PAS-PAS procedures included MV replacement (n = 19, 73.1%), MV repair (n = 5, 19.2%), and TV repair (n = 2, 7.7%). Sternotomy conversion was required in 5 patients (19.2%), of which 4 (15.4%) were early conversions due to lung adhesion and 1 (3.8%) due to a late intraoperative complication. The mean cardiopulmonary bypass and cross-clamp times were 163.3 ± 57.9 and 101.2 ± 43.8 min, respectively. Postoperative mechanical ventilation longer than 72 h was required in 4 patients (15.4%). In-hospital morbidities included hospital-acquired pneumonia (n = 3, 11.5%), postoperative air leaks (n = 2, 7.7%) and revision for bleeding (n = 1, 3.8%). The mean length of hospital stay was 16.1 days. Long-term clinical and echocardiographic follow-up were 48.3 ± 39.2 and 44.6 ± 32.9 months, respectively. The Kaplan-Meier analyses for survival and freedom from mitral and tricuspid valve reintervention (n = 26) at 5 years were 83.9 and 95.8%, respectively, with 91.3% of surviving patients classified as being NYHA II or less. Echocardiographic follow-up showed no residual mitral regurgitation more than grade I in all redo mitral valve repairs and no paravalvular leak post-valve replacement. CONCLUSIONS Redo-PAS-PAS is our routine approach and we apply this strategy in the majority of patients who had previous port access surgery. The predicted procedure-related mortality, morbidities, patient satisfaction and long-term outcomes are favourable.
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Affiliation(s)
- Johan van der Merwe
- Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium
| | - Filip Casselman
- Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium
| | - Bernard Stockman
- Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium
| | - Yvette Vermeulen
- Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium
| | - Ivan Degrieck
- Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium
| | - Frank Van Praet
- Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium
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van der Merwe J, Casselman F, Stockman B, Van Praet F, Beelen R, Maene L, Vermeulen Y, Degrieck I. Minimally invasive primary aortic valve surgery: the OLV Aalst experience. Ann Cardiothorac Surg 2015; 4:154-9. [PMID: 25870811 DOI: 10.3978/j.issn.2225-319x.2015.01.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 01/07/2015] [Indexed: 11/14/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate our in-hospital outcomes with primary J-sternotomy aortic valve surgery since the initiation of our program in 1997. METHODS Between October 1(st) 1997 and August 31(st) 2014, 768 patients (mean age: 69.1±11.2 years, 46.6% females, 15.6% aged greater than 80 years) underwent primary JS-AVS. Additional risk factors included diabetes mellitus (n=98, 12.2%), peripheral vascular disease (n=42, 5.5%) and body mass index greater than 30 (n=144, 18.8%). The mean logistical EuroSCORE I was 5.46%±4.5%. RESULTS Aortic valve replacement and repair were performed in 758 (98.7%) and 10 (1.3%) patients respectively, for isolated valve stenosis (n=472, 61.8%), incompetence (n=56, 7.3%) and mixed valve disease (n=236, 30.9%). Valve pathology included sclerosis (n=516, 67.2%), rheumatic disease (n=110, 14.3%) and endocarditis (n=10, 1.3%). Reasons for conversion to full sternotomy (n=23, 3.0%) included porcelain ascending aorta (n=3, 0.4%), inadequate visualization (n=2, 0.3%) and intra-operative complications (n=18, 2.3%). Mean length of hospital stay was 11.0±7.4 days. Morbidity included stroke (n=15, 2.0%), revision or re-exploration (n=52, 6.8%), atrial fibrillation (n=201, 26.2%) and sternitis (n=5, 0.7%). In-hospital mortality was 1.6% (n=12). Overall survival at 30 days was 98.0%. CONCLUSIONS JS-AVS is safe and is our routine approach for isolated aortic valve disease. Procedure related mortality is lower than predicted, conversion rates limited and significant morbidity minimal.
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Affiliation(s)
- Johan van der Merwe
- The Department of Cardiovascular and Thoracic Surgery, OLV-Clinic, Aalst, Belgium
| | - Filip Casselman
- The Department of Cardiovascular and Thoracic Surgery, OLV-Clinic, Aalst, Belgium
| | - Bernard Stockman
- The Department of Cardiovascular and Thoracic Surgery, OLV-Clinic, Aalst, Belgium
| | - Frank Van Praet
- The Department of Cardiovascular and Thoracic Surgery, OLV-Clinic, Aalst, Belgium
| | - Roel Beelen
- The Department of Cardiovascular and Thoracic Surgery, OLV-Clinic, Aalst, Belgium
| | - Lieven Maene
- The Department of Cardiovascular and Thoracic Surgery, OLV-Clinic, Aalst, Belgium
| | - Yvette Vermeulen
- The Department of Cardiovascular and Thoracic Surgery, OLV-Clinic, Aalst, Belgium
| | - Ivan Degrieck
- The Department of Cardiovascular and Thoracic Surgery, OLV-Clinic, Aalst, Belgium
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Ding C, Jiang DM, Tao KY, Duan QJ, Li J, Kong MJ, Shen ZH, Dong AQ. Anterolateral minithoracotomy versus median sternotomy for mitral valve disease: a meta-analysis. J Zhejiang Univ Sci B 2015; 15:522-32. [PMID: 24903989 DOI: 10.1631/jzus.b1300210] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Mitral valve disease tends to be treated with anterolateral minithoracotomy (ALMT) rather than median sternotomy (MS), as ALMT uses progressively smaller incisions to promote better cosmetic outcomes. This meta-analysis quantifies the effects of ALMT on surgical parameters and post-operative outcomes compared with MS. METHODS One randomized controlled study and four case-control studies, published in English from January 1996 to January 2013, were identified and evaluated. RESULTS ALMT showed a significantly longer cardiopulmonary bypass time (P=0.001) and aortic cross-clamp time (P=0.05) compared with MS. However, the benefits of ALMT were evident as demonstrated by a shorter length of hospital stay (P<0.00001). According to operative complications, the onset of new arrhythmias following ALMT decreased significantly as compared with MS (P=0.05); however, the incidence of peri-operative mortality (P=0.62), re-operation for bleeding (P=0.37), neurologic events (P=0.77), myocardial infarction (P=0.84), gastrointestinal complications (P=0.89), and renal insufficiency (P=0.67) were similar to these of MS. Long-term follow-up data were also examined, and revealed equivalent survival and freedom from mitral valve events. CONCLUSIONS Current clinical data suggest that ALMT is a safe and effective alternative to the conventional approach and is associated with better short-term outcomes and a trend towards longer survival.
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Affiliation(s)
- Chao Ding
- Department of Gynaecology, Zhejiang Cancer Hospital, Hangzhou 310022, China; Department of Cardiovascular Surgery, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China; Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510030, China
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Lamelas J, Nguyen TC. Minimally Invasive Valve Surgery: When Less Is More. Semin Thorac Cardiovasc Surg 2015; 27:49-56. [DOI: 10.1053/j.semtcvs.2015.02.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2015] [Indexed: 11/11/2022]
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Maltais S, Davis ME, Haglund N. Minimally invasive and alternative approaches for long-term LVAD placement: the Vanderbilt strategy. Ann Cardiothorac Surg 2014; 3:563-9. [PMID: 25512895 DOI: 10.3978/j.issn.2225-319x.2014.10.02] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 08/25/2014] [Indexed: 11/14/2022]
Abstract
BACKGROUND Minimally invasive and alternative strategies for implantation have been anecdotally reported for contemporary continuous-flow left ventricular assist device (CF-LVAD) placement. METHODS We reviewed our experience at a single center with alternative strategies for implantation of the HeartMate II and HeartWare CF-LVADs, in patients with advanced heart failure (HF). This featured article focuses on the associated surgical techniques and patient management pitfalls. RESULTS For appropriately selected cases, our group believes that these alternative strategies allow for the development of novel and less traumatic surgical approaches for CF-LVAD implantation. With reproducible outcomes, these approaches also promise the possibility of increasing the number of high-risk surgical patients who could benefit from CF-LVAD therapies. CONCLUSIONS This work has detailed a variety of less invasive alternative strategies for implantation of long-term LVADs. These newer approaches have the potential for significant advancements in the field of cardiothoracic surgery. Large-scale collaborative studies will be needed to clarify the potential advantages and disadvantages of these novel techniques on patient outcomes.
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Affiliation(s)
- Simon Maltais
- 1 Department of Cardiothoracic Surgery, 2 Division of Cardiovascular Medicine, Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN 37232-8808, USA
| | - Mary E Davis
- 1 Department of Cardiothoracic Surgery, 2 Division of Cardiovascular Medicine, Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN 37232-8808, USA
| | - Nicholas Haglund
- 1 Department of Cardiothoracic Surgery, 2 Division of Cardiovascular Medicine, Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN 37232-8808, USA
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Miceli A, Murzi M, Gilmanov D, Fugà R, Ferrarini M, Solinas M, Glauber M. Minimally invasive aortic valve replacement using right minithoracotomy is associated with better outcomes than ministernotomy. J Thorac Cardiovasc Surg 2014; 148:133-7. [DOI: 10.1016/j.jtcvs.2013.07.060] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 07/10/2013] [Accepted: 07/26/2013] [Indexed: 11/25/2022]
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Minimally invasive mitral valve procedures: the current state. Minim Invasive Surg 2013; 2013:679276. [PMID: 24382998 PMCID: PMC3870135 DOI: 10.1155/2013/679276] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 04/02/2013] [Indexed: 11/18/2022] Open
Abstract
Since its early days, cardiac surgery has typically involved large incisions with complete access to the heart and the great vessels. After the popularization of the minimally invasive techniques in general surgery, cardiac surgeons began to experiment with minimal access techniques in the early 1990s. Although the goals of minimally invasive cardiac surgery (MICS) are fairly well established as decreased pain, shorter hospital stay, accelerated recuperation, improved cosmesis, and cost effectiveness, a strict definition of minimally invasive cardiac surgery has been more elusive. Minimally invasive cardiac surgery started with mitral valve procedures and then gradually expanded towards other valve procedures, coronary artery bypass grafting, and various types of simple congenital heart procedures. In this paper, the authors attempt to focus on the evolution, techniques, results, and the future perspective of minimally invasive mitral valve surgery (MIMVS).
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Minimally Invasive and Conventional Aortic Valve Replacement: A Propensity Score Analysis. Ann Thorac Surg 2013; 96:837-43. [DOI: 10.1016/j.athoracsur.2013.04.102] [Citation(s) in RCA: 132] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Revised: 04/21/2013] [Accepted: 04/29/2013] [Indexed: 11/22/2022]
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Lucà F, van Garsse L, Rao CM, Parise O, La Meir M, Puntrello C, Rubino G, Carella R, Lorusso R, Gensini GF, Maessen JG, Gelsomino S. Minimally invasive mitral valve surgery: a systematic review. Minim Invasive Surg 2013; 2013:179569. [PMID: 23606959 PMCID: PMC3625540 DOI: 10.1155/2013/179569] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 02/07/2013] [Accepted: 02/17/2013] [Indexed: 12/04/2022] Open
Abstract
In the recent years minimally invasive mitral valve surgery (MIMVS) has become a well-established and increasingly used option for managing patients with a mitral valve pathology. Nonetheless, whether the purported benefits of MIMVS translate into clinically important outcomes remains controversial. Therefore, in this paper we provide an overview of MIMVS and discuss results, morbidity, mortality, and quality of life following mitral minimally invasive procedures. MIMVS has been proven to be a feasible alternative to the conventional full sternotomy approach with low perioperative morbidity and short-term mortality. Reported benefits of MIMVS include also decreased postoperative pain, improved postoperative respiratory function, reduced surgical trauma, and greater patient satisfaction. Finally, compared to standard surgery, MIMVS demonstrated comparable efficacy across a range of long-term efficacy measures such as freedom from reoperation and long-term survival.
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Affiliation(s)
- Fabiana Lucà
- Cardiothoracic and Cardiology Department, Maastricht University, The Netherlands
- Heart and Vessels Department, Careggi Hospital, Florence, Italy
- Cardiology Department, Paolo Borsellino Hospital, Marsala, Italy
| | - Leen van Garsse
- Cardiothoracic and Cardiology Department, Maastricht University, The Netherlands
| | | | - Orlando Parise
- Heart and Vessels Department, Careggi Hospital, Florence, Italy
| | - Mark La Meir
- Cardiothoracic and Cardiology Department, Maastricht University, The Netherlands
| | | | - Gaspare Rubino
- Cardiology Department, Paolo Borsellino Hospital, Marsala, Italy
| | - Rocco Carella
- Heart and Vessels Department, Careggi Hospital, Florence, Italy
| | - Roberto Lorusso
- Heart and Vessels Department, Careggi Hospital, Florence, Italy
| | | | - Jos G. Maessen
- Cardiothoracic and Cardiology Department, Maastricht University, The Netherlands
| | - Sandro Gelsomino
- Cardiothoracic and Cardiology Department, Maastricht University, The Netherlands
- Heart and Vessels Department, Careggi Hospital, Florence, Italy
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Vistarini N, Aiello M, Viganò M. Minimally invasive video-assisted cardiac surgery: operative techniques, application fields and clinical outcomes. Future Cardiol 2012; 7:775-87. [PMID: 22050064 DOI: 10.2217/fca.11.57] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Minimally invasive video-assisted surgery through a right minithoracotomy has become the standard surgical approach for several cardiac diseases at many major centers worldwide. In this article we review the existing literature on the subject and describe different operative techniques, application fields and clinical outcomes.
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Affiliation(s)
- Nicola Vistarini
- Division of Cardiac Surgery, Dipartimento di Scienze Chirurgiche, Rianimatorie, Riabilitative e dei Trapianti D'Organo, Fondazione IRCCS Policlinico San Matteo, Pavia University School of Medicine, Italy.
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Schmitto JD, Mokashi SA, Cohn LH. Minimally-Invasive Valve Surgery. J Am Coll Cardiol 2010; 56:455-62. [DOI: 10.1016/j.jacc.2010.03.053] [Citation(s) in RCA: 210] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Revised: 03/05/2010] [Accepted: 03/09/2010] [Indexed: 11/25/2022]
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Modi P, Hassan A, Chitwood WR. Minimally invasive mitral valve surgery: a systematic review and meta-analysis. Eur J Cardiothorac Surg 2008; 34:943-52. [PMID: 18829343 DOI: 10.1016/j.ejcts.2008.07.057] [Citation(s) in RCA: 334] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2008] [Revised: 07/19/2008] [Accepted: 07/28/2008] [Indexed: 10/21/2022] Open
Abstract
The mitral valve has been traditionally approached through a median sternotomy. However, significant advances in surgical optics, instrumentation, tissue telemanipulation, and perfusion technology have allowed for mitral valve surgery to be performed using progressively smaller incisions including the minithoracotomy and hemisternotomy. Due to reports of excellent results, minimally invasive mitral valve surgery has become a standard of care at certain specialized centers worldwide. This meta-analysis quantifies the effects of minimally invasive mitral valve surgery on morbidity and mortality compared with conventional mitral surgery and demonstrates equivalent perioperative mortality (1641 patients, odds ratio (OR) 0.46, 95% confidence interval 0.15-1.42, p=0.18), reduced need for reoperation for bleeding (1553 patients, OR 0.56, 95% CI 0.35-0.90, p=0.02) and a trend towards shorter hospital stays (350 patients, weighted mean difference (WMD) -0.73, 95% CI -1.52 to 0.05, p=0.07). These benefits were evident despite longer cardiopulmonary bypass (WMD 25.81, 95% CI 13.13-38.50, p<0.0001) and cross-clamp times (WMD 20.91, 95% CI 8.79-33.04, p=0.0007) in the minimally invasive group. Case-control studies show consistently less pain and faster recovery compared to those having a conventional approach. Data for minimally invasive mitral valve surgery after previous cardiac surgery are limited but consistently demonstrate reduced blood loss, fewer transfusions and faster recovery compared to reoperative sternotomy. Long-term follow-up data from multiple cohort studies are also examined revealing equivalent survival and freedom from reoperation. Thus, current clinical data suggest that minimally invasive mitral valve surgery is a safe and a durable alternative to a conventional approach and is associated with less morbidity.
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Affiliation(s)
- Paul Modi
- East Carolina Heart Institute, Greenville, NC 27834, USA
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Farhat F, Lu Z, Lefevre M, Montagna P, Mikaeloff P, Jegaden O. Prospective comparison between total sternotomy and ministernotomy for aortic valve replacement. J Card Surg 2003; 18:396-401; discussion 402-3. [PMID: 12974924 DOI: 10.1046/j.1540-8191.2003.02047.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Ministernotomy (MS) is an alternative for total sternotomy (TS) in aortic valve replacement. We compared these two approaches for results and adverse effects in a prospective study. From January to December 2000, 100 patients who underwent aortic valve replacement were included in two groups of 50 according to the surgical approach that used MS or TS; one senior surgeon performed all cases in each group. Valvular pathologies were either stenosis or insufficiency. Mean age was 63 +/- 14 years in MS, 67 +/- 12 in TS (p = ns). NYHA class was 2.7 +/- 0.5 in MS, 2.8 +/- 0.6 in TS (p = ns). Left ventricular ejection fraction was 58 +/- 12% in MS, 57 +/- 12% in TS (p = ns). There was a significant difference between MS and TS in aortic cross-clamping (66 +/- 14 min vs 48 +/- 9 min) and cardiopulmonary bypass (88 +/- 18 min vs 69 +/- 10 min, p < 0.01), but not in intervention times (2.8 +/- 0.4 hours vs 2.7 +/- 0.4 hours). Mean intensive care stay was reduced in MS (1.7 +/- 1.6 days vs 2.6 +/- 6 days, p < 0.05). Intubation times (12 +/- 7 hours vs 14 +/- 9 hours), 24 hours bleeding (394 +/- 219 mL vs 465 +/- 318), reintervention for hemostasis (4% vs 2%), rhythmic complications (14% vs 14%), and mortality at 1 month (2% vs 2%) were comparable in MS and TS. In aortic valve surgery, ministernotomy is technically more demanding and needs more time. It is as safe and as effective as conventional sternotomy but its eventual benefits, excepting upon cosmesis, are still to be defined.
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Affiliation(s)
- Fadi Farhat
- Department of Cardiac Surgery, Louis Pradel Hospital, Claude Bernard University, BP Lyon-Monchat, 69394 Lyon cedex 03, France
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Creswell LL, Damiano RJ. Postoperative atrial fibrillation: An old problem crying for new solutions. J Thorac Cardiovasc Surg 2003. [DOI: 10.1067/mtc.2003.214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Corbi P, Rahmati M, Donal E, Lanquetot H, Jayle C, Menu P, Allal J. Prospective comparison of minimally invasive and standard techniques for aortic valve replacement: initial experience in the first hundred patients. J Card Surg 2003; 18:133-9. [PMID: 12757340 DOI: 10.1046/j.1540-8191.2003.02002.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Aortic valve replacement (AVR) can be performed through a partial upper sternotomy. In this study we compared the early postoperative outcome in two groups of patients who underwent AVR with a minimally invasive procedure (n = 30) or with a conventional approach (n = 70). The predicted operative mortality (Parsonnet Index) was slightly higher in the conventional group (17.69 +/- 0.85 versus 12.7 +/- 1.02), reflecting the greater mean age of the patients (70.96 +/- 1.17 versus 64.20 +/- 2.57). RESULTS The distribution of the different etiologies of aortic valve pathology did not differ between groups. There was no postoperative death in the mini-invasive group. Cardiopulmonary bypass time was longer in the mini-invasive group, but the other operative parameters did not differ between groups. Postoperative morbidity regarding the need for blood transfusion, the duration of assisted ventilation, length of stay in the intensive care unit, and abnormalities of cardiac rhythm and conduction was slightly but not significantly reduced in the mini-invasive group. CONCLUSIONS Our data demonstrate that a partial upper sternotomy is a safe and effective technique for AVR. Postoperative morbidity is not significantly reduced in patients undergoing AVR by this approach. Further studies in a larger patient population are necessary to assess whether postoperative morbidity is significantly reduced.
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Affiliation(s)
- Pierre Corbi
- Département Médico-Chirurgical de Cardiologie, René Beauchant, Centre Hospitalier Universitaire de Poitiers, Rue de la Milétrie, Poitiers, France
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Creswell LL, Damiano RJ. Postoperative atrial fibrillation: an old problem crying for new solutions. J Thorac Cardiovasc Surg 2001; 121:638-41. [PMID: 11279402 DOI: 10.1067/mtc.2001.114347] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Byrne JG, Karavas AN, Cohn LH, Adams DH. Minimal access aortic root, valve, and complex ascending aortic surgery. Curr Cardiol Rep 2000; 2:549-57. [PMID: 11060583 DOI: 10.1007/s11886-000-0041-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We report our entire experience with minimal access aortic root, valve, and complex ascending aortic surgery. A total of 290 consecutive patients underwent aortic root, valve, and ascending aortic surgery between July 1996 and February 2000. Four groups were identified: isolated aortic valve replacement (AV group, n = 227), aortic root replacement (AR group, n = 44), aortic valve replacement with concomitant replacement of the supracoronary ascending aorta (V/A group, n = 9), and isolated ascending aortic replacement (AA group, n = 10). The procedures were performed through a partial upper hemisternotomy (87%) or a right parasternal approach (13%). Overall mortality was 3.1% (n = 7) for the AV group, 2.3% (n = 1) for the AR group, 0% for the V/A group, and 10.0% (n = 1) for the AA group. Complications included reoperation for bleeding in 10 (4.5%), two (4.7%), one (11.1%), and one (11.1%) for the four groups respectively; and sternal wound infection in eight (3.6%) patients of the AV group and one (2.3%) patient of the AR group. Five (2.3%) patients of the AV group suffered stroke. Isolated or more complicated aortic valve, root and ascending aortic surgery is feasible and safe through a minimally invasive approach with acceptable incidence of complications and mortality, without compromising the efficacy of the procedure.
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Affiliation(s)
- J G Byrne
- Division of Cardiac Surgery, Brigham & Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
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Abstract
Minimally invasive as it applies to aortic valve surgery refers to the exposure required to perform the aortic procedure, because total cardiopulmonary bypass is still required. Initial experience used the anterior thoracotomy, but recent series report the ministernotomy or "J" incision as the preferred technique for exposure. Though pain, blood loss, and length of stay may not be significantly different when compared with the conventional technique, lower costs and earlier recovery may be achieved. Minimally invasive aortic valve surgery is a technique that is still evolving.
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Affiliation(s)
- A L Estrera
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Texas 77030, USA
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