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Takeichi T, Morimoto Y, Yamada A, Tanaka T. Fifth-time redo mitral valve replacement via right thoracotomy under systemic hyperkalemia cardiopulmonary bypass without aortic cross-clamp. THE JOURNAL OF EXTRA-CORPOREAL TECHNOLOGY 2023; 55:201-205. [PMID: 38099636 PMCID: PMC10723575 DOI: 10.1051/ject/2023040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 09/21/2023] [Indexed: 12/17/2023]
Abstract
The surgical management of prosthetic valvular endocarditis (PVE) can be challenging. We report a case of a 46-year-old female patient who had a history of four cardiac operations. We chose a mitral valve replacement via right thoracotomy to enable optimal exposure of the mitral valve (MV). Because of multi-reoperations, we employed systemic hyperkalemia for cardiac arrest to protect the heart during cardiopulmonary bypass (CPB) without aortic cross-clamping. Here, we present a complex operation that performed management of CPB under hyperkalemia and the patient had a good postoperative recovery.
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Affiliation(s)
- Tomohisa Takeichi
- Department of Clinical Engineering, Kitaharima Medical Center 926-250, Ichiba-cho Ono-shi Hyogo 675-1392 Japan
| | - Yoshihisa Morimoto
- Department of Cardiovascular Surgery, Kitaharima Medical Center 926-250, Ichiba-cho Ono-shi Hyogo 675-1392 Japan
| | - Akitoshi Yamada
- Department of Cardiovascular Surgery, Kitaharima Medical Center 926-250, Ichiba-cho Ono-shi Hyogo 675-1392 Japan
| | - Takanori Tanaka
- Department of Clinical Engineering, Kitaharima Medical Center 926-250, Ichiba-cho Ono-shi Hyogo 675-1392 Japan
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Ventricular Fibrillatory Arrest: A Safe Option in Robotic Totally Endoscopic Intracardiac Surgery. Ann Thorac Surg 2022; 115:1438-1444. [PMID: 36539048 DOI: 10.1016/j.athoracsur.2022.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 11/12/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Moderate hypothermic ventricular fibrillatory arrest during heart surgery is an alternative to cardioplegic arrest in selected patients. We reviewed our experience using a ventricular fibrillatory arrest technique in robotic totally endoscopic intracardiac surgery. METHODS From February 2014 through July 2022, 128 patients who underwent robotic totally endoscopic intracardiac surgical procedures performed using moderate hypothermic ventricular fibrillatory arrest were reviewed. Patients were chosen based on the risk of aortic manipulation, complexity of the procedure, grade of aortic valve insufficiency and comorbidities, including history of prior cardiac surgery and peripheral vascular disease. RESULTS Patients were a mean age of 65 ± 14 years, and the mean The Society of Thoracic Surgeons score was 2.7 ± 2.9. Fourteen patients (11%) had a history of previous cardiac surgery. The intracardiac procedures were mitral valve surgery in 84 patients (66%), isolated cryomaze procedure in 27 (21%), and other in 17 (13%). The mean ventricular fibrillatory arrest time was 79 ± 26 minutes, and the mean cardiopulmonary bypass time was 174 ± 49 minutes. There was no conversion to sternotomy. Seven patients (5.5%) required inotropic support, and 2 patients (1.6%) needed an intra-aortic balloon pump. There was no incidence of postoperative stroke or clinical myocardial infarction. The mean hospital and intensive care unit lengths of stay were 3.1 ± 1.7 and 1.4 ± 0.7 days, respectively. One death (0.78%) occurred due to respiratory failure. CONCLUSIONS Moderate hypothermic ventricular fibrillatory arrest in robotic intracardiac surgery may be a safe and effective alternative in selected patients.
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Miura T, Tanigawa K, Matsukuma S, Matsumaru I, Hisatomi K, Hazama S, Tsuneto A, Eishi K. A right thoracotomy approach for mitral and tricuspid valve surgery in patients with previous standard sternotomy: comparison with a re-sternotomy approach. Gen Thorac Cardiovasc Surg 2016; 64:315-24. [PMID: 26968540 DOI: 10.1007/s11748-016-0638-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 03/02/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND To compare the outcomes of mitral and/or tricuspid valve surgery in patients with previous sternotomy between those who underwent a right thoracotomy and those who underwent re-sternotomy. METHODS Between October 2009 and May 2015, eighteen patients underwent a right thoracotomy (R group) and 28 underwent re-sternotomy (re-S group). The right thoracotomy was prioritized for previous coronary artery bypass grafting. Follow-up was 100 % complete with a mean follow-up of 1.9 ± 1.5 years for the R group and 2.5 ± 1.4 years for the re-S group (p = 0.2137). RESULTS Hypothermic ventricular fibrillation was applied in 33.3 % in the R group and in 7.1 % in the re-S group (p = 0.0424). Hospital mortality, the median intensive care unit stay, and the median postoperative hospital stay were 0 % versus 7.1 % (p = 0.5130), 3 days versus 2 days (p = 0.2370), and 28 days versus 29.5 days (p = 0.8043) for the R group versus the re-S group, respectively. Although the rate of major complications was comparable (R group 33.3 % versus re-S group 25.0 %, p = 0.5401), those contents were not equal. Deep sternum infection developed only in the re-S group (3.6 %) and reoperation for bleeding was required only in the R group (11.1 %). No significant difference was observed in the 2-year cardiac-related mortality-free rate (R group 93.3 ± 6.4 % versus re-S group 90.8 ± 6.4 %, p = 0.7516). CONCLUSIONS Given study limitations, the right thoracotomy approach after previous sternotomy provided favorable outcomes as well as re-sternotomy. When selecting a right thoracotomy for re-do mitral and/or tricuspid surgery, the surgical strategy needs to be thoroughly planned.
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Affiliation(s)
- Takashi Miura
- Department of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan.
| | - Kazuyoshi Tanigawa
- Department of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan
| | - Seiji Matsukuma
- Department of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan
| | - Ichiro Matsumaru
- Department of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan
| | - Kazuki Hisatomi
- Department of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan
| | - Shiro Hazama
- Department of Cardiovascular Surgery, Sasebo General Hospital, Nagasaki, Japan
| | - Akira Tsuneto
- Department of Cardiology, Nagasaki University Hospital, Nagasaki, Japan
| | - Kiyoyuki Eishi
- Department of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan
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Edelman JJB, Seco M, Dunne B, Matzelle SJ, Murphy M, Joshi P, Yan TD, Wilson MK, Bannon PG, Vallely MP, Passage J. Custodiol for myocardial protection and preservation: a systematic review. Ann Cardiothorac Surg 2014; 2:717-28. [PMID: 24349972 DOI: 10.3978/j.issn.2225-319x.2013.11.10] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 11/10/2013] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Custodiol cardioplegia is attractive for minimally invasive cardiac surgery, as a single dose provides a long period of myocardial protection. Despite widespread use in Europe, there is little data confirming its efficacy compared with conventional (blood or crystalloid) cardioplegia. There is similar enthusiasm for its use in organ preservation for transplant, but also a lack of data. This systematic review aimed to assess the evidence for the efficacy of Custodiol in myocardial protection and as a preservation solution in heart transplant. METHODS Electronic searches were performed of six databases from inception to October 2013. Reviewers independently identified studies that compared Custodiol with conventional cardioplegia (blood or extracellular crystalloid) in adult patients for meta-analysis; large case series that reported results using Custodiol were analyzed. Next, we identified studies that compared Custodiol with other organ preservation solutions for organ preservation in heart transplant. RESULTS Fourteen studies compared Custodiol with conventional cardioplegia for myocardial protection in adult cardiac surgery. No difference was identified in mortality; there was a trend for increased incidence of ventricular fibrillation in the Custodiol group that did not reach statistical significance. No difference was identified in studies that compared Custodiol with other solutions for heart transplant. CONCLUSIONS Despite widespread clinical use, the evidence supporting the superiority of Custodiol over other solutions for myocardial protection or organ preservation is limited. Large randomised trials are required.
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Affiliation(s)
- J James B Edelman
- Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Nedlands, Australia; ; The Baird Institute; Sydney Medical School, University of Sydney, Sydney, Australia
| | - Michael Seco
- The Baird Institute; Sydney Medical School, University of Sydney, Sydney, Australia
| | - Ben Dunne
- Department of Cardiothoracic Surgery, Royal Perth Hospital, Perth, Australia
| | - Shannon J Matzelle
- Department of Anaesthesia, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Michelle Murphy
- Department of Anaesthesia, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Pragnesh Joshi
- Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Tristan D Yan
- The Baird Institute; Sydney Medical School, University of Sydney, Sydney, Australia; ; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - Michael K Wilson
- The Baird Institute; Sydney Medical School, University of Sydney, Sydney, Australia; ; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia; ; Australian School of Advanced Medicine, Macquarie University, Sydney, Australia
| | - Paul G Bannon
- The Baird Institute; Sydney Medical School, University of Sydney, Sydney, Australia; ; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - Michael P Vallely
- The Baird Institute; Sydney Medical School, University of Sydney, Sydney, Australia; ; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia; ; Australian School of Advanced Medicine, Macquarie University, Sydney, Australia
| | - Jurgen Passage
- Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Nedlands, Australia; ; Notre Dame Medical School, Fremantle, Australia
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Hiraoka A, Kuinose M, Totsugawa T, Chikazawa G, Yoshitaka H. Mitral valve reoperation under ventricular fibrillation through right mini-thoracotomy using three-dimensional videoscope. J Cardiothorac Surg 2013; 8:81. [PMID: 23587412 PMCID: PMC3626926 DOI: 10.1186/1749-8090-8-81] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 04/08/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Conventional reoperative mitral valve surgery by median sternotomy has several difficulties. We performed mitral valve replacement (MVR) under ventricular fibrillation (VF) through right mini-thoracotomy with three-dimensional videoscope for avoiding the problems. METHODS Between 2006 and 2011, we performed 257 cases of MVR, in which 125 cases underwent isolated MVR. Ten cases of patients underwent reoperative MVR under VF through thoracotomy with three-dimensional videoscope (Group I), and 27 cases of patients underwent reoperative conventional MVR through median sternotomy (Group II). We retrospectively reviewed the outcomes and compared Group I with Group II. Preoperative left ventricular ejection fraction (LVEF) was significantly lower (50.5 ± 19.8% vs 64.4 ± 12.0%; p = 0.046), and significantly higher Euro SCORE was found in Group I (4.8 ± 2.0 vs 3.8 ± 2.4; p = 0.037). RESULTS Although Group I required cooling and rewarming time, average operative times was significantly shorter in Group I (262 ± 46 min vs 300 ± 57 min; p = 0.044), and cardiopulmonary bypass times and average VF times in Group I and aortic cross-clamp times in Group II were equivalent. There was no significant difference in the average of postoperative maximum creatine kinase (CK)-MB. In-hospital mortality was 0/10 (0%) and 1/27 (3.7%), and postoperative paravalvular leakage occurred in 0/10 (0%) and 1/27 (3.7%), and stroke occurred in 1/10 (10%) and 1/27 (3.7%) for Groups I and II. Two patients underwent reoperation for bleeding in Group II. Intensive care unit stay in Group I was significantly shorter than in Group II (1.8 ± 0.6 days vs 3.0 ± 1.7 days; p = 0.025). CONCLUSIONS The higher risk of preoperative background in Group I had no effect on the operation. Mitral valve surgery under VF through right mini-thoracotomy can be an alternative procedure for reoperation after conventional various cardiothoracic surgeries.
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Affiliation(s)
- Arudo Hiraoka
- Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, 2-5-1 Nakaicho, Okayama, Kita-ku 700-0804, Japan.
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Less Invasive Intracardiac Surgery Performed Without Aortic Clamping. Ann Thorac Surg 2008; 85:1551-5. [DOI: 10.1016/j.athoracsur.2008.01.071] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2007] [Revised: 01/22/2008] [Accepted: 01/23/2008] [Indexed: 11/17/2022]
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Murakami T, Kuinose M, Takagaki M, Inagaki E. Mitral valve replacement through right thoracotomy after previous coronary artery bypass grafting: the usefulness of brachial artery cannulation, perfused ventricular fibrillation with moderate hypothermia, and minimal dissection techniques. ACTA ACUST UNITED AC 2004; 52:26-9. [PMID: 14760988 DOI: 10.1007/s11748-004-0057-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
It has been reported by several authors that a right thoracotomy for mitral valve surgery can be useful after previous coronary aortery bypass grafting (CABG). A 76-year-old man with mitral valve regurgitation after previous CABG underwent mitral valve replacement with some modified techniques. Cardiopulmonary bypass was established with right brachial artery cannulation and right femoral venous cannulation with the aid of vacuum-assisted venous drainage. Ventricular fibrillation (VF) was induced by rapid pacing of the ventricle, and mitral valve replacement was performed under perfused VF with moderate hypothermia. The patient's postoperative course was uneventful. This method appears to be a safe and easy alternative mitral valve surgery for complicated cases of this type.
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Affiliation(s)
- Takashi Murakami
- Department of Cardiovascular Surgery, Iwakuni National Hospital, 2-5-1 Kuroiso-cho, Iwakuni, Yamaguchi 740-8510, Japan
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Imanaka K, Kyo S, Ogiwara M, Gojo S, Kato M, Tanabe H, Ohuchi H, Asano H, Yokote Y. Noncardioplegic surgery for ischemic mitral regurgitation. Circ J 2003; 67:31-4. [PMID: 12520148 DOI: 10.1253/circj.67.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Twenty-seven consecutive patients underwent surgery for ischemic mitral regurgitation (MR): papillary muscle rupture (1), papillary muscle dysfunction (11) and annular dilatation (15). The grade of MR was moderate or severe, and the ejection fraction (EF) was less than 30% in 8 patients (mean, 43%). Three cases were reoperation and 3 were emergencies. Under ventricular fibrillation (VF) and intermittent aortic cross-clamping at moderate hypothermia, coronary artery bypass grafting (CABG) was performed first, followed by the mitral procedure through a right-sided left atriotomy (repair 21, replacement 6) performed under VF with the heart perfused through the native coronary arteries and CABG grafts. Concomitant procedures were CABG (23), Dor's procedure (5), and tricuspid annuloplasty (3). In one reoperative case with cardiogenic shock, CABG was impossible because of dense adhesions and the patient died just after surgery (hospital mortality, 3.7%). Five patients required intra-aortic balloon pump (IABP) support intraoperatively, but none required prolonged (> or =7 days) inotropic support or IABP use, although the serum concentrations of creatine kinase and its myocardial fraction were elevated remarkably. Other morbid events were refractory ventricular arrhythmia in one case and stroke in another. Median duration of mechanical ventilation and intensive care unit stay was 8 h and 3 days, respectively. Mean EF at hospital discharge was 48%. The extended period of VF was not associated with unfavorable clinical outcomes. Noncardioplegic surgery for ischemic MR was carried out with acceptable mortality and morbidity, and can be a good alternative, especially when clamping the aorta is undesirable.
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Affiliation(s)
- Kazuhito Imanaka
- Department of Cardiovascular Surgery, Saitama Medical School, Japan.
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