Thorac cardiovasc Surg
DOI: 10.1055/s-0039-1692403
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Minithoracotomy and Beating Heart Strategy for Mitral Surgery in Secondary Mitral Regurgitation

1  Department of Adult Cardiac Surgery, Hôpital Cardiologique Louis Pradel, Lyon Medical School, Lyon, France
2  Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
4  Sinai Biodesign and department of neurosurgery at Icahn School of Medicine and Mount Sinai Health system, New York, New York
,
Matteo Pozzi
1  Department of Adult Cardiac Surgery, Hôpital Cardiologique Louis Pradel, Lyon Medical School, Lyon, France
,
Marine Bordet
1  Department of Adult Cardiac Surgery, Hôpital Cardiologique Louis Pradel, Lyon Medical School, Lyon, France
,
Kaled Adamou Nouhou
1  Department of Adult Cardiac Surgery, Hôpital Cardiologique Louis Pradel, Lyon Medical School, Lyon, France
,
Young Joon Kwon
4  Sinai Biodesign and department of neurosurgery at Icahn School of Medicine and Mount Sinai Health system, New York, New York
,
Jean-François Obadia
1  Department of Adult Cardiac Surgery, Hôpital Cardiologique Louis Pradel, Lyon Medical School, Lyon, France
,
Marco Vola
1  Department of Adult Cardiac Surgery, Hôpital Cardiologique Louis Pradel, Lyon Medical School, Lyon, France
3  Department of Cardiovascular Surgery, Saint-Etienne Medical School, Saint-Etienne, France
› Author Affiliations
Further Information

Publication History

30 January 2019

25 April 2019

Publication Date:
26 June 2019 (online)

Abstract

Background In patients with secondary mitral regurgitation (MR) associated with low ejection fraction or previous heart surgery, minimally invasive mitral valve surgery without aortic cross-clamp (MIMVS-WAC) has shown promising results. We report our experience for this strategy in our centers.

Methods Between August 2011 and April 2017, 46 patients (mean age 69 ± 11 years, 76% males) received MIMVS-WAC. Indications for this technique were prior coronary bypass surgery (26%), severe or recent left ventricular (LV) dysfunction (30%), or both (39%). The mean EuroSCORE II was 12 ± 10.

Results For each procedure, we conducted right minithoracotomy and hypothermic cardiopulmonary bypass (CPB) after peripheral cannulation. Mean CPB time was 159 ± 39 minutes. A mitral valve replacement (MVR) was performed in 23 cases (50%), an annuloplasty in 22 cases (48%), and a prosthesis pannus removal in 1 case (2%). Mean hospital length of stay was 12 ± 5.4 days. We report no sternotomy conversions, six reoperations for bleeding, and three deaths at 30 days. Transfusion was requested in 62% (mean infusion 2 ± 2.4 packed red blood cells). The postoperative echocardiography showed an LV function preservation in 69% of cases and a reduction of pulmonary arterial pressure in 73% of cases. Four additional deaths occurred in the long-term follow-up (mean 637 ± 381 days, median 593 days). No mitral reoperation was required, with a MR ≤ 2 in 90% of patients.

Conclusion In high-risk patients, the MIMVS-WAC is a safe technique. It avoids hard dissections while ensuring excellent preservation of cardiac function.

Note

There is no meeting presentation.