Minithoracotomy and Beating Heart Strategy for Mitral Surgery in Secondary Mitral Regurgitation
30 January 2019
25 April 2019
26 June 2019 (online)
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.
Keywordsmitral valve surgery - minimally mitral invasive surgery - beating heart - high risk surgery
There is no meeting presentation.
- 1 Sündermann SH, Czerny M, Falk V. Open vs. minimally invasive mitral valve surgery: surgical technique, indications and results. Cardiovasc Eng Technol 2015; 6 (02) 160-166
- 2 Ghoneim A, Bouhout I, Mazine A. , et al. Beating heart minimally invasive mitral valve surgery in patients with patent coronary bypass grafts. Can J Cardiol 2016; 32 (08) 987.e1-987.e6
- 3 Xu RB, Rahnavardi M, Nadal M. , et al. Beating heart minimally invasive mitral valve surgery in patients with previous sternotomy: the operative technique and early outcomes. Open Heart 2018; 5 (01) e000749
- 4 Cao H, Zhou Q, Fan F, Xue Y, Pan J, Wang D. Right anterolateral thoracotomy: an attractive alternative to repeat sternotomy for high-risk patients undergoing reoperative mitral and tricuspid valve surgery. J Cardiothorac Surg 2017; 12 (01) 85
- 5 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
- 6 Milani R, Brofman PR, Oliveira S. , et al. Minimally invasive redo mitral valve surgery without aortic crossclamp. Rev Bras Cir Cardiovasc 2013; 28 (03) 325-330
- 7 Pasic M, Sündermann S, Unbehaun A, Kempfert J, Jacobs S, Falk V. Beating heart mitral valve surgery: results in 120 consecutive patients considered unsuitable for conventional mitral valve surgery. Interact Cardiovasc Thorac Surg 2017; 25 (04) 541-547
- 8 Holzhey DM, Seeburger J, Misfeld M, Borger MA, Mohr FW. Learning minimally invasive mitral valve surgery: a cumulative sum sequential probability analysis of 3895 operations from a single high-volume center. Circulation 2013; 128 (05) 483-491
- 9 Baumgartner H, Falk V, Bax JJ. , et al; ESC Scientific Document Group. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 2017; 38 (36) 2739-2791
- 10 Botta L, Cannata A, Bruschi G. , et al. Minimally invasive approach for redo mitral valve surgery. J Thorac Dis 2013; 5 (Suppl. 06) S686-S693
- 11 Garbade J, Seeburger J, Merk DR. , et al. Mitral valve pathology in severely impaired left ventricles can be successfully managed using a right-sided minimally invasive surgical approach. Eur J Cardiothorac Surg 2013; 44 (01) e1-e7
- 12 Goldstein D, Moskowitz AJ, Gelijns AC. , et al; CTSN. Two-year outcomes of surgical treatment of severe ischemic mitral regurgitation. N Engl J Med 2016; 374 (04) 344-353
- 13 Murzi M, Miceli A, Di Stefano G. , et al. Minimally invasive right thoracotomy approach for mitral valve surgery in patients with previous sternotomy: a single institution experience with 173 patients. J Thorac Cardiovasc Surg 2014; 148 (06) 2763-2768
- 14 Vassileva CM, Boley T, Markwell S, Hazelrigg S. Meta-analysis of short-term and long-term survival following repair versus replacement for ischemic mitral regurgitation. Eur J Cardiothorac Surg 2011; 39 (03) 295-303
- 15 Mihos CG, Santana O. Mitral valve repair for ischemic mitral regurgitation: lessons from the Cardiothoracic Surgical Trials Network randomized study. J Thorac Dis 2016; 8 (01) E94-E99
- 16 Maltais S, Schaff HV, Daly RC. , et al. Mitral regurgitation surgery in patients with ischemic cardiomyopathy and ischemic mitral regurgitation: factors that influence survival. J Thorac Cardiovasc Surg 2011; 142 (05) 995-1001
- 17 Calafiore AM, Iacò AL, Gallina S, Al-Amri H, Penco M, Di Mauro M. Surgical treatment of functional mitral regurgitation. Int J Cardiol 2013; 166 (03) 559-571
- 18 Cheng DC, Martin J, Lal A. , et al. Minimally invasive versus conventional open mitral valve surgery: a meta-analysis and systematic review. Innovations (Phila) 2011; 6 (02) 84-103
- 19 Ding C, Jiang DM, Tao KY. , et al. Anterolateral minithoracotomy versus median sternotomy for mitral valve disease: a meta-analysis. J Zhejiang Univ Sci B 2014; 15 (06) 522-532
- 20 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
- 21 Maganti M, Badiwala M, Sheikh A. , et al. Predictors of low cardiac output syndrome after isolated mitral valve surgery. J Thorac Cardiovasc Surg 2010; 140 (04) 790-796
- 22 Obadia J-F, Messika-Zeitoun D, Leurent G. , et al; MITRA-FR Investigators. Percutaneous repair or medical treatment for secondary mitral regurgitation. N Engl J Med 2018; 379 (24) 2297-2306
- 23 Santana O, Funk M, Zamora C, Escolar E, Lamas GA, Lamelas J. Staged percutaneous coronary intervention and minimally invasive valve surgery: results of a hybrid approach to concomitant coronary and valvular disease. J Thorac Cardiovasc Surg 2012; 144 (03) 634-639
- 24 Nakamura T, Izutani H, Sekiya N, Nakazato T, Sawa Y. Beating heart mitral valve repair for a patient with previous coronary bypass: a case report and review of the literature. J Cardiothorac Surg 2013; 8 (01) 187
- 25 Rossi A, Dini FL, Faggiano P. , et al. Independent prognostic value of functional mitral regurgitation in patients with heart failure. A quantitative analysis of 1256 patients with ischaemic and non-ischaemic dilated cardiomyopathy. Heart 2011; 97 (20) 1675-1680
- 26 Stone GW, Lindenfeld J, Abraham WT. , et al; COAPT Investigators. Transcatheter mitral-valve repair in patients with heart failure. N Engl J Med 2018; 379 (24) 2307-2318
- 27 Maisano F, Taramasso M, Nickenig G. , et al. Cardioband, a transcatheter surgical-like direct mitral valve annuloplasty system: early results of the feasibility trial. Eur Heart J 2016; 37 (10) 817-825
- 28 Ad N, Holmes SD, Shuman DJ, Pritchard G, Massimiano PS. Minimally invasive mitral valve surgery without aortic cross-clamping and with femoral cannulation is not associated with increased risk of stroke compared with traditional mitral valve surgery: a propensity score-matched analysis. Eur J Cardiothorac Surg 2015; 48 (06) 868-872 , discussion 872
- 29 Wani ML, Ahangar AG, Singh S. , et al. Efficacy and safety of beating heart mitral valve replacement. Int Cardiovasc Res J 2014; 8 (02) 61-65
- 30 Umakanthan R, Petracek MR, Leacche M. , et al. Minimally invasive right lateral thoracotomy without aortic cross-clamping: an attractive alternative to repeat sternotomy for reoperative mitral valve surgery. J Heart Valve Dis 2010; 19 (02) 236-243