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Tariq MA, Malik MK, Uddin QS, Altaf Z, Zafar M. Minimally Invasive Procedure versus Conventional Redo Sternotomy for Mitral Valve Surgery in Patients with Previous Cardiac Surgery: A Systematic Review and Meta-Analysis. J Chest Surg 2023; 56:374-386. [PMID: 37817430 PMCID: PMC10625962 DOI: 10.5090/jcs.23.038] [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: 03/20/2023] [Revised: 07/03/2023] [Accepted: 07/22/2023] [Indexed: 10/12/2023] Open
Abstract
Background The heightened morbidity and mortality associated with repeat cardiac surgery are well documented. Redo median sternotomy (MS) and minimally invasive valve surgery are options for patients with prior cardiac surgery who require mitral valve surgery (MVS). We conducted a systematic review and meta-analysis comparing the outcomes of redo MS and minimally invasive MVS (MIMVS) in this population. Methods We searched PubMed, EMBASE, and Scopus for studies comparing outcomes of redo MS and MIMVS for MVS. To calculate risk ratios (RRs) for binary outcomes and weighted mean differences (MDs) for continuous data, we employed a random-effects model. Results We included 12 retrospective observational studies, comprising 4157 participants (675 for MIMVS; 3482 for redo MS). Reductions in mortality (RR, 0.54; 95% confidence interval [CI], 0.37-0.80), length of hospital stay (MD, -4.23; 95% CI, -5.77 to -2.68), length of intensive care unit (ICU) stay (MD, -2.02; 95% CI, -3.17 to -0.88), and new-onset acute kidney injury (AKI) risk (odds ratio, 0.34; 95% CI, 0.19 to 0.61) were statistically significant and favored MIMVS (p<0.05). No significant differences were observed in aortic cross-clamp time, cardiopulmonary bypass time, or risk of perioperative stroke, new-onset atrial fibrillation, surgical site infection, or reoperation for bleeding (p>0.05). Conclusion The current literature, which primarily consists of retrospective comparisons, underscores certain benefits of MIMVS over redo MS. These include decreased mortality, shorter hospital and ICU stays, and reduced AKI risk. Given the lack of high-quality evidence, prospective randomized control trials with adequate power are necessary to investigate long-term outcomes.
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Affiliation(s)
- Muhammad Ali Tariq
- Department of Surgery, Dow University Hospital, Dow University of Health Sciences, Karachi, Pakistan
| | - Minhail Khalid Malik
- Department of Surgery, Dow University Hospital, Dow University of Health Sciences, Karachi, Pakistan
| | - Qazi Shurjeel Uddin
- Department of Surgery, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Zahabia Altaf
- Department of Surgery, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Mariam Zafar
- Department of Surgery, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
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Statzer NJ, Plackis AC, Woolard AA, Allen BFS, Siegrist KK, Shi Y, Shotwell M. Erector Spinae Plane Catheter Analgesia in Minimally Invasive Mitral Valve Surgery: A Retrospective Case-Control Study for Inclusion in an Enhanced Recovery Program. Semin Cardiothorac Vasc Anesth 2022; 26:266-273. [PMID: 35617152 DOI: 10.1177/10892532221104420] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. A retrospective case-control study was conducted to assess the feasibility of erector spinae plane (ESP) block as part of a multimodal enhanced recovery program for patients undergoing minimally invasive mitral valve replacement surgery. Methods. This retrospective analysis was conducted at a single center between January and August 2019. 61 patients were included; 23 received ESP and 38 did not. Erector spinae catheters (ESCs) were placed preoperatively, using a loading dose of 30 mL .5% ropivacaine, followed by an infusion of .2% ropivacaine at 10 mL/h throughout the study period. Primary outcome was 48-hour opioid consumption. Secondary outcomes included intraoperative morphine equivalents, extubation within 24 hours, reintubation, ICU length of stay and hospital length of stay and 30-day mortality. Results. Median [inter-quartile range] of the postoperative morphine milligram equivalents (MMEs) in the first 48 hours was 70[45-121] MMEs in the ESC) group, and 109[70-148] MMEs in the no ESC group (P-value = .16). No significant difference was observed in intraoperative morphine equivalents, extubation within 24 hours or ICU length of stay. The ESC group had shorter hospital length of stay (6.0 vs 7.0 days, P-value = .043). Conclusion. This study found a statistically insignificant, though potentially clinically significant reduction in postoperative opioid consumption. A reduced hospital length of stay as well as an acceptable safety profile was also observed in the ESC group. An adequately powered, prospective trial is warranted to accurately assess the potential role for ESP catheters for patients undergoing minimally invasive mitral valve surgery.
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Affiliation(s)
- Nicholas J Statzer
- Division of Multispecialty Anesthesiology, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Andreas C Plackis
- Anesthesiology, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Austin A Woolard
- Division of Cardiothoracic Anesthesiology, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Brian F S Allen
- Division of Multispecialty Anesthesiology, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kara K Siegrist
- Division of Cardiothoracic Anesthesiology, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yaping Shi
- Department of Biostatistics, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Matthew Shotwell
- Department of Biostatistics, 12328Vanderbilt University Medical Center, Nashville, TN, USA
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Hussain A, Chacko J, Uzzaman M, Hamid O, Butt S, Zakai SB, Khan H. Minimally invasive (mini-thoracotomy) versus median sternotomy in redo mitral valve surgery: A meta-analysis of observational studies. Asian Cardiovasc Thorac Ann 2021; 29:893-902. [PMID: 33611952 DOI: 10.1177/0218492321997084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Redo mitral valve surgery has traditionally been performed via a median sternotomy. It is often challenging and is associated with increased perioperative mortality. Advances in cardiac surgical techniques over the last two decades have led to an increase in the use of a minimally invasive approach via a right anterolateral mini-thoracotomy as opposed to a repeat median sternotomy. However, despite these advances, there is no general consensus on the best form of entry, and as of yet, there are no randomized controlled trials. We performed a meta-analysis of observational studies to aid in determining the best approach for redo mitral valve surgery. METHOD The MEDLINE and EMBASE databases were conducted up until 1 June 2020. Data regarding mortality, stroke, reoperation for bleeding and length of hospital stay, wound infection and cardiopulmonary bypass time were extracted and submitted to a meta-analysis using random effects modelling and the I2-test for heterogeneity. Seven retrospective observational studies were included, enrolling a total of 1070 patients. RESULTS There were a total of 1070 patients. Of these 364 had non-sternotomy approach compared with 707 patients who had median sternotomy. Further subgroup analysis revealed that 327 of the 364 patients had a mini-thoracotomy approach while the remaining 37 patients had a full thoracotomy approach. In-hospital mortality and length of stay were less in non-sternotomy group compared to median sternotomy group. There were no differences in stroke, CPB time and wound infections between the two groups. CONCLUSION Redo mitral valve surgery can be performed safely with satisfactory outcomes via a mini-thoracotomy approach. This meta-analysis shows comparable results with reduced in-hospital mortality and hospital length of stay with a mini-thoracotomy approach.
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Affiliation(s)
- Azhar Hussain
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
| | - Jacob Chacko
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
| | - Mohsin Uzzaman
- Department of Cardiac Surgery, Queen Elizabeth Hospital, Birmingham, UK
| | - Osama Hamid
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
| | - Salman Butt
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
| | - Saad Badar Zakai
- National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Habib Khan
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
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Daemen JHT, Heuts S, Olsthoorn JR, Maessen JG, Sardari Nia P. Right minithoracotomy versus median sternotomy for reoperative mitral valve surgery: a systematic review and meta-analysis of observational studies. Eur J Cardiothorac Surg 2018; 54:817-825. [DOI: 10.1093/ejcts/ezy173] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 03/26/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jean H T Daemen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+ (MUMC+), Maastricht, Netherlands
| | - Samuel Heuts
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+ (MUMC+), Maastricht, Netherlands
- Faculty of Health, Medicine and Life Sciences, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands
| | - Jules R Olsthoorn
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+ (MUMC+), Maastricht, Netherlands
| | - Jos G Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+ (MUMC+), Maastricht, Netherlands
- Faculty of Health, Medicine and Life Sciences, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands
| | - Peyman Sardari Nia
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+ (MUMC+), Maastricht, Netherlands
- Faculty of Health, Medicine and Life Sciences, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands
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Minimally Invasive Redo Mitral Valve Replacement using a Robotic-Assisted Approach. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017. [DOI: 10.1177/155698451701200511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Patel H, Lewis TPC, Stephens RL, Angelillo M, Sibley DH. Minimally Invasive Redo Mitral Valve Replacement using a Robotic-Assisted Approach. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017; 12:375-377. [DOI: 10.1097/imi.0000000000000411] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Minimally invasive, robotic-assisted cardiac surgery has been shown to decrease transfusion rates, decrease wound infection rates, shorten hospital length of stay, and allow for a faster return to full activity compared with traditional sternotomy approaches. However, its application has chiefly been limited to primary, isolated procedures such as primary mitral valve repair or replacement. We describe the first reported use of a robotic surgery platform to perform reoperative mitral valve replacement using a minimally invasive, totally endoscopic, port-access approach.
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Affiliation(s)
- Hetal Patel
- From the Division of Cardiac Surgery, Princeton Baptist Medical Center, Birmingham, AL USA
| | - T. P. Clifton Lewis
- From the Division of Cardiac Surgery, Princeton Baptist Medical Center, Birmingham, AL USA
| | - Richard L. Stephens
- From the Division of Cardiac Surgery, Princeton Baptist Medical Center, Birmingham, AL USA
| | - Margaret Angelillo
- From the Division of Cardiac Surgery, Princeton Baptist Medical Center, Birmingham, AL USA
| | - David H. Sibley
- From the Division of Cardiac Surgery, Princeton Baptist Medical Center, Birmingham, AL USA
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Esper SA, Bottiger BA, Ginsberg B, Del Rio JM, Glower DD, Gaca JG, Stafford-Smith M, Neuburger PJ, Chaney MA. CASE 8--2015. Paravertebral Catheter-Based Strategy for Primary Analgesia After Minimally Invasive Cardiac Surgery. J Cardiothorac Vasc Anesth 2015; 29:1071-80. [PMID: 26070694 DOI: 10.1053/j.jvca.2015.02.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Stephen A Esper
- Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
| | - Brandi A Bottiger
- Department of Anesthesiology, Duke University Medical Center, Durham, NC
| | - Brian Ginsberg
- Department of Anesthesiology, Duke University Medical Center, Durham, NC
| | - J Mauricio Del Rio
- Department of Anesthesiology, Duke University Medical Center, Durham, NC
| | - Donald D Glower
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Jeffrey G Gaca
- Department of Surgery, Duke University Medical Center, Durham, NC
| | | | - Peter J Neuburger
- Department of Anesthesiology, New York University Medical Center, New York, NY
| | - Mark A Chaney
- Department of Anesthesia and Critical Care, The University of Chicago, Chicago, IL
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Mitropoulos FA, Kanakis MA, Chatzis A, Contrafouris C, Sofianidou IA, Lioulias AG. Minimal invasive coronary artery fistula ligation. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2015; 47:545-7. [PMID: 25551078 PMCID: PMC4279827 DOI: 10.5090/kjtcs.2014.47.6.545] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 04/16/2014] [Accepted: 04/16/2014] [Indexed: 12/04/2022]
Abstract
A coronary artery fistula was surgically ligated in a 38-year-old woman via a left anterior mini-thoracotomy without the use of cardiopulmonary bypass. In selected cases, this surgical approach can provide an excellent surgical exposure for coronary artery fistula ligation. It also offers an excellent cosmetic result and shorter hospital stay.
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Affiliation(s)
- Fotios A Mitropoulos
- Department of Pediatric and Congenital Heart Surgery, Onassis Cardiac Surgery Center
| | - Meletios A Kanakis
- Department of Pediatric and Congenital Heart Surgery, Onassis Cardiac Surgery Center
| | - Andrew Chatzis
- Department of Pediatric and Congenital Heart Surgery, Onassis Cardiac Surgery Center
| | | | - Ioanna A Sofianidou
- Department of Pediatric and Congenital Heart Surgery, Onassis Cardiac Surgery Center
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Park JB, Kim SH, Lee SA, Chung JW, Kim JS, Chee HK. Effects of ulinastatin on postoperative blood loss and hemostasis in atrioventricular valve surgery with cardiopulmonary bypass. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2013; 46:185-91. [PMID: 23772405 PMCID: PMC3680603 DOI: 10.5090/kjtcs.2013.46.3.185] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 10/25/2012] [Accepted: 10/26/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cardiopulmonary bypass (CPB) induces variable systemic inflammatory reactions associated with major organ dysfunction via polymorphonuclear neutrophils (PMNs). Ulinastatin, a urinary trypsin inhibitor, inhibits PMN activity and reduces systemic inflammatory responses. The aim of this study is to evaluate the effect of ulinastatin on postoperative blood loss and laboratory changes in patients undergoing open heart surgery. MATERIALS AND METHODS Between January 2008 and February 2009, 110 patients who underwent atrioventricular valve surgery through right thoracotomy were divided into two groups. Patients received either 5,000 U/kg ulinastatin (ulinastatin group, n=41) or the equivalent volume of normal saline (control group, n=69) before aortic cross clamping. The primary end points were early coagulation profile changes, postoperative blood loss, transfusion requirements, and duration of intubation and intensive care unit stay. RESULTS There were no statistically significant differences between the two groups in early coagulation profile, other perioperative laboratory data, and postoperative blood loss with transfusion requirements. CONCLUSION Administration of ulinastatin during operation did not improve the early coagulation profile, postoperative blood loss, or transfusion requirements of patients undergoing open heart surgery. In addition, no significant effect of ulinastatin was observed in major organs dysfunction, systemic inflammatory reactions, or other postoperative profiles.
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Affiliation(s)
- Jae Bum Park
- Department of Thoracic and Cardiovascular Surgery, Konkuk University School of Medicine, Korea
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