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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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2
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Chen Y, Chen LW, Dai XF, Huang XS. Open Seldinger-guided peripheral femoro-femoral cannulation technique for totally endoscopic cardiac surgery. J Cardiothorac Surg 2021; 16:199. [PMID: 34294106 PMCID: PMC8296695 DOI: 10.1186/s13019-021-01584-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/10/2021] [Indexed: 12/29/2022] Open
Abstract
Background The cannulation technique used in totally endoscopic cardiac surgery has a significant impact on the overall prognosis of patients. However, there are no large cohort studies to discuss it. Here we report on our research of using open Seldinger-guided technique to establish femoro-femoral cardiopulmonary bypass during totally endoscopic cardiac surgery and evaluate its safety and efficacy. Methods The institutional database from 2017 to 2020 was retrospectively reviewed to find cases in which totally endoscopic cardiac surgery was performed. We identified 214 consecutive patients who underwent totally endoscopic cardiac surgery with peripheral femoro-femoral cannulation. All patients underwent femoral artery cannulation. Of these, 201 were cannulated in the femoral vein and 13 were cannulated in the femoral vein combined with internal jugular cannulation. The technique involves surgically exposing the femoral vessel, setting up purse-string over the vessels and then inserting a guidewire into the femoral vessel without a vascular incision, followed by exchange of the guidewire with a cannula. Results Surgery indications included mitral valve disease in 82.71% (177/214), atrial septal defect in 11.68% (25/214) and tricuspid regurgitation in the remaining 5.61% (12/214). Hospital survival was 98.60% (211/214). There were no cases of stroke and postoperative limb ischaemia. No femoral vessel injuries or wound infections was observed. No late pseudoaneurysms were evident. Conclusion The open Seldinger-guided femoro-femoral cannulation technique is effective and safe. We highly recommend this technique, given its safety, simplicity and speed under direct vision. The limited manipulation of the vessels under direct vision minimizes the risk of local complications. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-021-01584-x.
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Affiliation(s)
- Yi Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China.,Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, China
| | - Liang-Wan Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Xiao-Fu Dai
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Xue-Shan Huang
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, China. .,Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, China.
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Chen Y, Huang LC, Chen DZ, Chen LW, Zheng ZH, Dai XF. Totally endoscopic mitral valve surgery: early experience in 188 patients. J Cardiothorac Surg 2021; 16:91. [PMID: 33865420 PMCID: PMC8052820 DOI: 10.1186/s13019-021-01464-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 04/05/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Totally endoscopic technique has been widely used in cardiac surgery, and minimally invasive totally endoscopic mitral valve surgery has been developed as an alternative to median sternotomy for many patients with mitral valve disease. In this study, we describe our experience about a modified minimally invasive totally endoscopic mitral valve surgery and reported the preliminary results of totally endoscopic mitral valve surgery. The aim of this retrospective study is to evaluate the results of totally endoscopic technique in mitral valve surgery. MATERIAL AND METHODS We retrospectively reviewed the profiles of 188 patients who were treated for mitral valve disease by modified totally endoscopic mitral valve surgery at our institution between January 2019 and December 2020. The procedure was performed under endoscopic right minithoracotomy and with femoro-femoral cannulation using the single two-stage venous cannula. RESULTS A total of 188 patients underwent total endoscopic mitral valve surgery. Fifty-six patients had concomitant tricuspid valvuloplasty, 11 patients underwent concomitant ablation of atrial fibrillation and atrial septal defect repair was performed in three patients. Only one patient postoperatively died of multi-organ failure. Two patients were converted to median sternotomy. Except for one patient underwent operation to stop the bleeding from the incision site, no other serious complications nor reintervention occurred during the follow-up period. CONCLUSIONS The modified totally endoscopic mitral valve surgery performed at our institution is technically feasible and safe with the same efficacy as reported studies.
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Affiliation(s)
- Yi Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China
| | - Ling-Chen Huang
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China.
| | - Dao-Zhong Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China
| | - Liang-Wan Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China
| | - Zi-He Zheng
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China
| | - Xiao-Fu Dai
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China.
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Kastengren M, Svenarud P, Källner G, Franco-Cereceda A, Liska J, Gran I, Dalén M. Minimally invasive versus sternotomy mitral valve surgery when initiating a minimally invasive programme. Eur J Cardiothorac Surg 2020; 58:1168-1174. [PMID: 32920639 DOI: 10.1093/ejcts/ezaa232] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/15/2020] [Accepted: 05/23/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES An increasing number of mitral valve operations are performed using minimally invasive procedures. The initiation of a minimally invasive mitral valve surgery programme constitutes a unique opportunity to study outcome differences in patients with similar characteristics operated on through a sternotomy versus a minimally invasive procedure. The goal of this study was to compare short-term outcomes of patients undergoing mitral valve surgery before versus those having surgery after the introduction of a minimally invasive programme. METHODS The single-centre study included mitral valve procedures performed through a sternotomy or with a minimally invasive approach between January 2012 and May 2019. Propensity score matching was performed to reduce selection bias. RESULTS A total of 605 patients (294 sternotomy, 311 minimally invasive) who underwent mitral valve surgery were included in the analysis. Propensity score matching resulted in 251 matched pairs. In the propensity score-matched analysis, minimally invasive procedures had longer extracorporeal circulation duration (149 ± 52 vs 133 ± 57 min; P = 0.001) but shorter aortic occlusion duration (97 ± 36 vs 105 ± 40 min, P = 0.03). Minimally invasive procedures were associated with a lower incidence of reoperation for bleeding (2.4% vs 7.2%; P = 0.012), lower need for transfusion (19.1% vs 30.7%; P = 0.003) and shorter in-hospital stay (5.0 ± 2.7 vs 7.2 ± 4.6 days; P < 0.001). The 30-day mortality was low in both groups (0.4% vs 0.8%; P = 0.56). CONCLUSIONS Minimally invasive mitral valve surgery was associated with short-term outcomes comparable to those with procedures performed through a sternotomy. Initiating a minimally invasive mitral valve programme with a limited number of surgeons and a well-executed institutional selection strategy did not confer an increased risk for adverse events.
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Affiliation(s)
- Mikael Kastengren
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Peter Svenarud
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Göran Källner
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Franco-Cereceda
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Jan Liska
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Isak Gran
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Magnus Dalén
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
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Zia K, Mangi AR, Bughio H, Tariq K, Chaudry PA, Karim M. Initial Experience of Minimally Invasive Concomitant Aortic and Mitral Valve Replacement/Repair at a Tertiary Care Cardiac Centre of a Developing Country. Cureus 2019; 11:e5707. [PMID: 31720175 PMCID: PMC6823070 DOI: 10.7759/cureus.5707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Minimally invasive double valve replacement (DVR) surgery through a small transverse anterior thoracotomy is an alternate technique to sternotomy for concomitant aortic and mitral valve (AVR, MVR) surgery. The aim of this study was to evaluate the in-hospital and early outcomes of direct vision minimal invasive double valve surgery (DVMI-DVR) at a tertiary care cardiac center of a developing country. Methods This study was conducted at the National Institute of Cardiovascular Diseases Karachi, Pakistan from January 2018 to September 2018. Nineteen consecutive patients undergoing DVMI-DVR for aortic and mitral disease without any prior cardiac surgery were included in this study. For all procedures, access was obtained through small transverse anterior thoracotomy incision with wedge resection (Chaudhry’s Wedge) of sternum opposite to the third and fourth costosternal joints. Patients were observed during their hospital stay and the following variables were observed the length of hospital stay (LOHS), ventilator support, intensive care unit (ICU) stay, pain score, and mortality. The pain score was assessed using the visual analog scale (VAS). Results The male/female ratio was 11:8 with a mean age of 35 ± 12 years with mean EuroSCORE of 6.6 ± 3.5%. The mean total bypass time was 129.8 ± 23.83 min (range: 98-181 minutes). The mean mechanical ventilation time was 3.16 ± 1.12 hours (range: 2-6 hours). The mean intensive care unit (ICU) stay was 41.84 ± 8.36 hours. The mean post-operative LOHS was 5.63 ± 1.12 days (range: 4-8 days). We had zero frequency of wound infection and surgical mortality. The mean pain score was 4.32 (on a predefined pain scale of one to nine with a high value indicating severe pain). Conclusion Minimally invasive DVR surgery is a safe and reproducible technique with comparable outcomes such as postoperative pain score (4.32 ± 2.05), ventilation time (3.16 ± 1.12 hours), ICU stay (41.84 ± 8.36 hours), and hospital stay (5.63 ± 1.12 days). In terms of mortality, operative times, ICU stay, and hospital stay, the minimally invasive DVR is at least comparable to those achieved with median sternotomy. Further prospective randomized studies are needed to validate our findings.
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Affiliation(s)
- Kashif Zia
- Cardiac Surgery, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Ali R Mangi
- Cardiac Surgery, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Hafeezullah Bughio
- Cardiac Surgery, National Institute of Cardiovascular Disease, Karachi, PAK
| | - Khuzaima Tariq
- Cardiac Surgery, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Pervaiz A Chaudry
- Cardiac Surgery, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Musa Karim
- Miscellaneous, National Institute of Cardiovascular Diseases, Karachi, PAK
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Hawkins RB, Mehaffey JH, Mullen MG, Nifong WL, Chitwood WR, Katz MR, Quader MA, Kiser AC, Speir AM, Ailawadi G. A propensity matched analysis of robotic, minimally invasive, and conventional mitral valve surgery. Heart 2018; 104:1970-1975. [PMID: 29915143 DOI: 10.1136/heartjnl-2018-313129] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 05/01/2018] [Accepted: 05/08/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Institutional studies suggest robotic mitral surgery may be associated with superior outcomes. The objective of this study was to compare the outcomes of robotic, minimally invasive (mini), and conventional mitral surgery. METHODS A total of 2300 patients undergoing non-emergent isolated mitral valve operations from 2011 to 2016 were extracted from a regional Society of Thoracic Surgeons database. Patients were stratified by approach: robotic (n=372), mini (n=576) and conventional sternotomy (n=1352). To account for preoperative differences, robotic cases were propensity score matched (1:1) to both conventional and mini approaches. RESULTS The robotic cases were well matched to the conventional (n=314) and mini (n=295) cases with no significant baseline differences. Rates of mitral repair were high in the robotic and mini cohorts (91%), but significantly lower with conventional (76%, P<0.0001) despite similar rates of degenerative disease. All procedural times were longest in the robotic cohort, including operative time (224 vs 168 min conventional, 222 vs 180 min mini; all P<0.0001). The robotic approach had comparable outcomes to the conventional approach except there were fewer discharges to a facility (7% vs 15%, P=0.001) and 1 less day in the hospital (P<0.0001). However, compared with the mini approach, the robotic approach had more transfusions (15% vs 5%, P<0.0001), higher atrial fibrillation rates (26% vs 18%, P=0.01), and 1 day longer average hospital stay (P=0.02). CONCLUSION Despite longer procedural times, robotic and mini patients had similar complication rates with higher repair rates and shorter length of stay metrics compared with conventional surgery. However, the robotic approach was associated with higher atrial fibrillation rates, more transfusions and longer postoperative stays compared with minimally invasive approach.
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Affiliation(s)
- Robert B Hawkins
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - J Hunter Mehaffey
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Matthew G Mullen
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Wiley L Nifong
- Division of Cardiac Surgery, East Carolina University, Greenville, North Carolina, USA
| | - W Randolph Chitwood
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Marc R Katz
- Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Mohammed A Quader
- Division of Cardiothoracic Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Andy C Kiser
- Division of Cardiac Surgery, East Carolina University, Greenville, North Carolina, USA
| | - Alan M Speir
- INOVA Heart and Vascular Institute, Falls Church, Virginia, USA
| | - Gorav Ailawadi
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia, USA
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Minimally invasive mitral valve surgery is associated with excellent resource utilization, cost, and outcomes. J Thorac Cardiovasc Surg 2018; 156:611-616.e3. [PMID: 29709359 DOI: 10.1016/j.jtcvs.2018.03.108] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 03/12/2018] [Accepted: 03/25/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Minimally invasive mitral valve surgery (mini-MVR) has numerous associated benefits. However, many studies fail to include greater-risk patients. We hypothesized that a minimally invasive approach in a representative cohort provides excellent outcomes with reduced resource utilization. METHODS Mitral valve surgical records from 2011 to 2016 were paired with institutional financial records. Patients were stratified by approach and propensity-score matched to balance preoperative difference. The primary outcomes of interest were resource utilization including cost, discharge to a facility, and readmission. RESULTS A total of 478 patients underwent mitral surgery (21% mini-MVR) and were balanced after matching (n = 74 per group), with 18% of patients having nondegenerative mitral disease. Outcomes were excellent with similar rates of major morbidity (9.5% mini-MVR vs 10.8% conventional, P = .78). Mini-MVR cases had lower rates of transfusion (11% vs 27%, P = .01) and shorter ventilator times (3.7 vs 6.0 hours, P < .0001). Mean total hospital cost was equivalent ($49,703 vs $54,970, P = .235) with mini-MVR having lower ancillary ($1645 vs $2652, P = .001) and blood costs ($383 vs $1058, P = .001). These savings were offset by longer surgical times (291 vs 234 minutes, P < .0001) with greater surgical ($7645 vs $7293, P = .0001) and implant costs ($1148 vs $748, P = .03). Rates of discharge to a facility (9.6% vs 16.2%) and readmission (9.6% vs 4.1%) were not statistically different. CONCLUSIONS In a real-world cohort, mini-MVR continues to demonstrate excellent results with a favorable resource utilization profile. Greater surgical and implant costs with mini-MVR are offset by decreased transfusions and ancillary needs leading to equivalent overall hospital cost.
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Minimally Invasive Mitral Valve Surgery I: Patient Selection, Evaluation, and Planning. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017; 11:243-50. [PMID: 27654407 PMCID: PMC5051530 DOI: 10.1097/imi.0000000000000301] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Widespread adoption of minimally invasive mitral valve repair and replacement may be fostered by practice consensus and standardization. This expert opinion, first of a 3-part series, outlines current best practices in patient evaluation and selection for minimally invasive mitral valve procedures, and discusses preoperative planning for cannulation and myocardial protection.
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Minimally Invasive Mitral Valve Surgery II: Surgical Technique and Postoperative Management. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017; 11:251-9. [PMID: 27654406 PMCID: PMC5051532 DOI: 10.1097/imi.0000000000000300] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Techniques for minimally invasive mitral valve repair and replacement continue to evolve. This expert opinion, the second of a 3-part series, outlines current best practices for nonrobotic, minimally invasive mitral valve procedures, and for postoperative care after minimally invasive mitral valve surgery.
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Sakaguchi T. Minimally invasive mitral valve surgery through a right mini-thoracotomy. Gen Thorac Cardiovasc Surg 2016; 64:699-706. [PMID: 27638268 DOI: 10.1007/s11748-016-0713-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 09/09/2016] [Indexed: 11/29/2022]
Abstract
Since its introduction in the mid-1990s, minimally invasive mitral valve surgery (MIMVS) has been shown to be a feasible alternative to a conventional full-sternotomy approach, and several studies have reported excellent clinical outcomes with low perioperative morbidity and mortality. As a result, MIMVS is being increasingly employed as a routine procedure worldwide. On the other hand, several issues have been raised, including complications specific to this technique and its steep learning curve, while there are also concerns regarding the durability of a mitral valve repair through a limited access. In this study, the current status and future perspectives of MIMVS were examined.
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Affiliation(s)
- Taichi Sakaguchi
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, 2-5-1 Nakai-cho, Kita-ku, Okayama, Okayama, 700-0804, Japan.
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Martínez Ochoa CM, Cañas EM, Castro Pérez JA, Saldarriaga Giraldo CI, González Berrío C, González Jaramillo N. Valor predictivo del EuroSCORE II y el STS score en pacientes sometidos a cirugía cardiaca valvular por el abordaje mínimamente invasivo. REVISTA COLOMBIANA DE CARDIOLOGÍA 2016. [DOI: 10.1016/j.rccar.2015.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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12
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Misfeld M, Borger M, Byrne JG, Chitwood WR, Cohn L, Galloway A, Garbade J, Glauber M, Greco E, Hargrove CW, Holzhey DM, Krakor R, Loulmet D, Mishra Y, Modi P, Murphy D, Nifong LW, Okamoto K, Seeburger J, Tian DH, Vollroth M, Yan TD. Cross-sectional survey on minimally invasive mitral valve surgery. Ann Cardiothorac Surg 2013; 2:733-8. [PMID: 24349974 DOI: 10.3978/j.issn.2225-319x.2013.11.11] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 11/09/2013] [Indexed: 11/14/2022]
Abstract
BACKGROUND Minimally invasive mitral valve surgery (MIMVS) has become a standard technique to perform mitral valve surgery in many cardiac centers. However, there remains a question regarding when MIMVS should not be performed due to an increased surgical risk. Consequently, expert surgeons were surveyed regarding their opinions on patient factors, mitral valve pathology and surgical skills in MIMVS. METHODS Surgeons experienced in MIMVS were identified through an electronic search of the literature. A link to an online survey platform was sent to all surgeons, as well as two follow-up reminders. Survey responses were then submitted to a central database and analyzed. RESULTS The survey was completed by 20 surgeons. Overall results were not uniform with regard to contraindications to performing MIMVS. Some respondents do not consider left atrial enlargement (95% of surgeons), complexity of surgery (75%), age (70%), aortic calcification (70%), EuroSCORE (60%), left ventricular ejection fraction (55%), or obesity (50%) to be contraindication to surgery. Ninety percent of respondents believe more than 20 cases are required to gain familiarity with the procedure, while 85% believe at least one MIMVS case needs to be performed per week to maintain proficiency. Eighty percent recommend establishment of multi-institutional databases and standardized surgical mentoring courses, while 75% believe MIMVS should be incorporated into current training programs for trainees. CONCLUSIONS These results suggest that MIMVS has been accepted as a treatment option for patients with mitral valve pathologies according the expert panel. Initial training and continuing practice is recommended to maintain proficiency, as well as further research and formalization of training programs.
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Affiliation(s)
- Martin Misfeld
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
| | - Michael Borger
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
| | - John G Byrne
- Departmemnt of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - W Randolph Chitwood
- Department of Cardiovascular Sciences, East Carolina University, Greenville, NC, USA
| | - Lawrence Cohn
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Aubrey Galloway
- Department of Cardiothoracic Surgery, New York University Medical Center, New York, NY, USA
| | - Jens Garbade
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
| | - Mattia Glauber
- Cardiac Surgery Department, G. Pasquinucci Heart Hospital, Massa, Italy
| | - Ernesto Greco
- Departments of Cardiovascular Surgery and Anaesthesia, Policlinica Gipuzkoa, San Sebastian, Spain
| | - Clark W Hargrove
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - David M Holzhey
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
| | - Ralf Krakor
- Heart Center Dortmund, Klinikum Dortmund gGmbH, Dortmund, Germany
| | - Didier Loulmet
- Department of Cardiothoracic Surgery, New York University Medical Center, New York, NY, USA
| | - Yugal Mishra
- Department of Cardiac Surgery, Escorts Heart Institute and Research Centre Ltd, Okhla Road, New Delhi, India
| | - Paul Modi
- Liverpool Heart and Chest Hospital, Liverpool, UK
| | | | - L Wiley Nifong
- Department of Cardiovascular Sciences, East Carolina University, Greenville, NC, USA
| | - Kazuma Okamoto
- Department of Cardiovascular Surgery, Keio University, Tokyo, Japan
| | - Joerg Seeburger
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
| | - David H Tian
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Marcel Vollroth
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
| | - Tristan D Yan
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
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