Minimally Invasive Mitral Valve Surgery in Re-Do Cases—The New Standard Procedure?
20 September 2017
03 January 2018
28 February 2018 (online)
Background Minimally invasive mitral valve surgery (MIMVS) is superior to “classical” mitral valve surgery via a sternotomy regarding wound healing and postoperative pain. It is however a more challenging procedure. Patients' preference is leading clearly toward minimally invasive approaches, and surgeons are driven by upcoming new technologies in interventional procedures such as the MitraClip. Especially in re-do cases, the access via right mini-thoracotomy, as previously non-operated situs, is a possible advantage over a re-sternotomy. We therefore retrospectively analyzed our result regarding MIMVS in re-do cases at our institute.
Methods From January 2011 and June 2016, 33 operations were MIMVS re-do procedures. Mean age was 60 years (±16 years), and 51% were male.
Results Sixty-one percent were elective cases, 29% were urgent cases, and 9% were emergency operations. Operation times, cardiopulmonary bypass (CPB) times, and clamp times were 235 minutes (±51 min), 149 minutes (±42 min), and 62 minutes (±45min), respectively. Mitral valve repair and replacement was performed in 24% (n = 8) and 76% (n = 25), respectively. Overall in-hospital mortality, apoplexy, and re-operation rates (all for bleeding) were 0% (n = 0), 3% (n = 1), and 9% (n = 3). New onset of dialysis was required in two (6%) patients. Two (6%) patients developed superficial wound infection. Overall intensive care unit (ICU) and hospital stay was 3 days (±4 days) and 15 days (±7 days), respectively.
Conclusion MIMVS for re-do cases can be performed with minimal mortality and morbidity and therefore represents a safe alternative to conventional mitral valve surgery in cardiac re-do operations. However, postoperative morbidity is highly dependent on preoperative patient status.
These often multi-morbid patients require a close collaboration for their individual treatment intra- as well as postoperativly, and a lot of effort concerning the optimal therapeutic strategy has to be applied. Accordingly, to further evaluate these patients to publish the data, different departments have to closely collaborate. Therefore, the authors of this publication exceed the maximum of seven. The authors have made the following contribution to this publication: J.S. was involved in data collection and writing of the manuscript; F.F. was involved in data evaluation, writing of the manuscript, revision of the paper, statistical analysis, and designing of the study; J.N. was mainly responsible for data collection as part of his doctoral thesis; M.S. was responsible for designing of the study; G.W. was performing operations and involved in the review of the manuscript as well as statistical evaluation; S.R. was involved in data collection and responsible for the figures; S.C. and A.H. were involved in designing the study as well as performing the operations; and I.T. was responsible as senior author for the data evaluation, writing of the manuscript as well as revision, and performed the operations.
This study has been presented at the DGTHG annual meeting in Leipzig 2017 as an oral presentation.
- 1 Goldstone AB, Woo YJ. Is minimally invasive thoracoscopic surgery the new benchmark for treating mitral valve disease?. Ann Cardiothorac Surg 2016; 5 (06) 567-572
- 2 Moscarelli M, Fattouch K, Casula R, Speziale G, Lancellotti P, Athanasiou T. What is the role of minimally invasive mitral valve surgery in high-risk patients? A meta-analysis of observational studies. Ann Thorac Surg 2016; 101 (03) 981-989
- 3 Partida RA, Elmariah S. Transcatheter mitral valve interventions: current therapies and future directions. Curr Treat Options Cardiovasc Med 2017; 19 (05) 32
- 4 Byrne JG, Aranki SF, Adams DH, Rizzo RJ, Couper GS, Cohn LH. Mitral valve surgery after previous CABG with functioning IMA grafts. Ann Thorac Surg 1999; 68 (06) 2243-2247
- 5 Steimle CN, Bolling SF. Outcome of reoperative valve surgery via right thoracotomy. Circulation 1996; 94 (9, Suppl): II126-II128
- 6 Ricci D, Pellegrini C, Aiello M. , et al. Port-access surgery as elective approach for mitral valve operation in re-do procedures. Eur J Cardiothorac Surg 2010; 37 (04) 920-925
- 7 Santana O, Krishna R, Kherada N, Mihos CG. Outcomes of minimally invasive valve surgery in patients with multiple previous cardiac operations. J Heart Valve Dis 2016; 25 (04) 487-490
- 8 Nagendran J, Catrip J, Losenno KL, Adams C, Kiaii B, Chu MW. Minimally invasive mitral repair surgery: why does controversy still persist?. Expert Rev Cardiovasc Ther 2017; 15 (01) 15-24
- 9 Glauber M, Miceli A. State of the art for approaching the mitral valve: sternotomy, minimally invasive or total endoscopic robotic?. Eur J Cardiothorac Surg 2015; 48 (05) 639-641
- 10 Moscarelli M, Bianchi G, Margaryan R. , et al. Accuracy of EuroSCORE II in patients undergoing minimally invasive mitral valve surgery. Interact Cardiovasc Thorac Surg 2015; 21 (06) 748-753 . Doi: 10.1093/icvts/ivv265
- 11 Casselman FP, La Meir M, Jeanmart H. , et al. Endoscopic mitral and tricuspid valve surgery after previous cardiac surgery. Circulation 2007; 116 (11, Suppl): I270-I275
- 12 Seeburger J, Borger MA, Falk V. , et al. Minimally invasive mitral valve surgery after previous sternotomy: experience in 181 patients. Ann Thorac Surg 2009; 87 (03) 709-714