scholarly journals Comparison of Totally Thoracoscopic and Traditional Sternotomy Approaches for Mitral Valve Replacement

2019 ◽  
Vol 22 (4) ◽  
pp. E310-E314
Author(s):  
He Fan ◽  
Qian Xi Ming ◽  
Zhang Wei Min ◽  
Chen Huai Dong
Keyword(s):  
Cardiopulmonary Bypass ◽  
Postoperative Complications ◽  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Median Sternotomy ◽  
Traditional Group ◽  
Thoracoscopic Approach ◽  
Postoperative Drainage ◽  
The Right

Background: We aimed to investigate the feasibility and safety of mitral valve replacement using a totally thoracoscopic approach in comparison with traditional median sternotomy. Methods: Between January 2016 and December 2017, 94 consecutive patients who underwent mitral valve replacement were divided into two groups: A thoracoscopic group (43 cases) and a traditional group (51 cases). For the thoracoscopic group, all patients underwent total thoracoscopic procedures with femoral arterial and venous cannulation to cardiopulmonary bypass, transthoracic aortic cross-clamp, and antegrade cardioplegia. Three intercostal ports in the right chest were used for access in the thoracoscopic group. The operation was performed completely under two-dimensional video. For the traditional group, all operations were done with traditional median sternotomy. Results: All the operations were successfully performed. The thoracoscopic group had longer aortic cross-clamping and cardiopulmonary bypass times compared with the traditional group (62.30 ± 8.17 minutes versus 44.90 ± 12.00 minutes, P < .001; 92.33 ± 12.03 minutes versus 74.22 ± 14.72 minutes, P < .001). The two groups did not show statistically significant differences with respect to operative times (184.26 ± 32.49 minutes versus 181.47 ± 23.31 minutes, P = .631). In addition, the postoperative mechanical ventilation, ICU stay, and postoperative hospital stay times and postoperative drainage were 10.14 ± 2.21 hours and 11.35 ± 2.58 hours (P = .016), 21.40 ± 3.15 hours and 29.12 ± 6.59 hours (P < .001), 8.70 ± 2.52 days and 10.04 ± 3.11 days (P = .023), and 325.71 ± 97.11 mL and 396.57 ± 121.50 mL (P < .001), respectively. Major postoperative complications occurred in three (6.98%, P = .873) cases of the thoracoscopic group. Four (7.84%) cases of the traditional group had postoperative complications. Conclusions: Despite the disadvantages such as long cross-clamp and cardiopulmonary bypass times, totally thoracoscopic mitral valve replacement is feasible and safe. More importantly, one of the principal advantages with three intercostal ports over standard sternotomy is avoiding retrosternal adhesion, thus lowering the risk of needing to redo a cardiac procedure in the future.

Acquired submitral aneurysms may be associated with mitral paravalvular leaks

2021 ◽  
pp. 021849232110063
Author(s):  
Palaparti Raghuram ◽  
Kothandam Sivakumar ◽  
Ejaz Ahamed Sheriff
Keyword(s):  
Cardiopulmonary Bypass ◽  
High Risk ◽  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Transcatheter Closure ◽  
Alternative Solution ◽  
Surgical Trauma ◽  
Ideal Solution ◽  
Repeat Surgery

Acquired submitral aneurysm after mitral valve replacement is caused by weakness of the annular tissues induced by inflammation, scarring, and ischemia from surgical trauma. The asynchronous stretch of the annulus caused by the submitral aneurysm may cause recurrent paravalvular leaks. In patients with acquired submitral aneurysms and paravalvular leaks, ideal solution is a repeat surgery to address both the aneurysm and the leak. However, when patients are at high risk for repeat surgeries on cardiopulmonary bypass through sternotomy, transcatheter closure of these paravalvar leaks may offer an alternative solution. Four such procedures in three patients are detailed in this report.

Republished: A case of right middle cerebral artery ‘tendonectomy’ following mitral valve replacement surgery

2017 ◽  
Vol 9 (9) ◽  
pp. e35-e35 ◽  
Author(s):  
Mary C Thomas ◽  
Josser E Delgado Almandoz ◽  
Adam J Todd ◽  
Mark L Young ◽  
Jennifer L Fease ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Middle Cerebral Artery ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Cerebral Artery ◽  
Mechanical Thrombectomy ◽  
Chordae Tendineae ◽  
Replacement Surgery ◽  
The Right ◽  
Valve Replacement Surgery

Following mechanical mitral valve replacement surgery, a 69-year-old woman had an ischemic stroke in the right middle cerebral artery territory. Mechanical thrombectomy showed the embolus to be a piece of chordae tendineae excised during the valve replacement surgery.

scholarly journals Cardiac surgery in patients with heparin induced thombocytopenia (HIT II)

2009 ◽  
Vol 56 (1) ◽  
pp. 47-52
Author(s):  
M.D. Jovic ◽  
D.G. Nezic ◽  
B.M. Calija ◽  
D.S. Nenadic ◽  
A.M. Knezevic ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Anticoagulant Therapy ◽  
Anticoagulation Therapy ◽  
Thrombin Inhibitors ◽  
Postoperative Treatment ◽  
Per Oral

Heparin-induced thrombocytopenia (HIT) might be lifethreatening in patients undergoing open heart surgery, due to thromboembolic events, thrombocytopenia and bleeding. If cardiac surgery with cardiopulmonary bypass (CPB) is necessary, anticoagulation therapy will be based on usage of danaparoid or direct thrombin inhibitors. Female patient was switched from per oral anticoagulant therapy to low molecular heparin therapy preparing for reredo mitral valve replacement due to endocarditis and artificial valve thrombosis. In next 10 days, thrombocytopenia was obvious (Tr 302 000 mm3 to 11 000 mm3) , and diagnoses of HIT were done. Anticoagulant therapy was continued with danaparoid, 750 IU/12 h sc. During the surgery, reredo mitral valve replacement and aortocoronary bypass on anterior descending coronary artery, blood salvage technique with rhirudin( intravenous bolus 0,4 mg/kg, in CPB prajming solution 0,4mg/kg and continuous infusion during CPB 0,15 mg/kg/h ) during cardiopulmonary bypass was used. Active coagulation time and +++ were monitored, without any sign of micro thrombosis in circuit. Postoperatively, per oral anticoagulation therapy was initiated with prolonged postoperative treatment due to basic disease, endocarditis. Patient was discharged from hospital on 21-st postoperative day without any complication.

scholarly journals MINIMALLY INVASIVE MITRAL VALVE REPLACEMENT (MIMVR) THROUGH RIGHT MINITHORACOTOMY: A SINGLE-CENTER EXPERIENCE FROM CENTRAL INDIA

2022 ◽  
Vol 6 (1) ◽  
Author(s):  
Piyush Gupta ◽  
Manish Porwal
Keyword(s):  
Mitral Valve ◽  
Minimally Invasive ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Operating Time ◽  
Median Sternotomy ◽  
Central India ◽  
Good Alternative ◽  
Mitral Valve Surgery ◽  
Mortality And Morbidity

Background: Minimally invasive mitral valve replacement surgery (MIMVR) is gaining popularity for its multifold advantages. Here we report our single-institution experience with MIMVR through the right minithoracotomy over two years. Materials and Methods: This study was a retrospective analytical study. Forty-two patients undergoing MIMVR between August 2019 and July 2021 were included. Recorded perioperative data were collected and evaluated retrospectively. Results: A total of 42 patients were included in the study, of which 29 were females (69%). The mean age was 43.2+/- 8.2 years. Overall 30-day mortality was 2.38% (n = 1). Mean operating time, cardiopulmonary bypass, and aortic cross-clamp times were 264.9 ± 48.7, 151.5 ± 39.8, and 89.8 ± 25.6 minutes, respectively. Tricuspid valve annuloplasty was performed in 8 patients (19%). One patient (2.38%) required conversion to median sternotomy, and three patients (7.1%) underwent re-explorations due to bleeding. The median postoperative hospital stay was 5 days. Conclusions: MIMVR through right minithoracotomy is feasible, safe, and reproducible with low mortality and morbidity. Mitral valve surgery through a small anterior thoracotomy is a good alternative to conventional thoracotomy. Keywords: minimally invasive, minithoracotomy, mitral valve replacement

scholarly journals Ministernotomy: A preliminary experience in heart valve surgery

2011 ◽  
Vol 68 (5) ◽  
pp. 405-409
Author(s):  
Pavle Kovacevic ◽  
Bogoljub Mihajlovic ◽  
Lazar Velicki ◽  
Aleksandar Redzek ◽  
Vladimir Ivanovic ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Mitral Valve ◽  
Minimally Invasive ◽  
Median Sternotomy ◽  
Valve Surgery ◽  
Site Infection ◽  
Duration Of Hospital Stay ◽  
Extubation Time ◽  
Postoperative Drainage ◽  
Cerebrovascular Insult

Background/Aim. The last decade of the 20th century brought up a significant development in the field of minimally invasive approaches to the valvular heart surgery. Potential benefits of this method are: good esthetic appearance, reduced pain, reduction of postoperative hemorrhage and incidence of surgical site infection, shorter postoperative intensive care units (ICU) period and overall in-hospital period. Partial upper median sternotomy currently presents as a state-of-the art method for minimally invasive surgery of cardiac valves. The aim of this study was to report on initial experience in application of this surgical method in the surgery of mitral and aortic valves. Methods. The study was designed and conducted in a prospective manner and included all the patients who underwent minimally invasive cardiac valve surgery through the partial upper median sternotomy during the period November 2008 - August 2009. We analyzed the data on mean age of patients, mean extubation time, mean postoperative drainage, mean duration of hospital stay, as well as on occurance of postoperative complications (postoperative bleeding, surgical site infection and cerebrovascular insult). Results. During the observed period, in the Institute for Cardiovascular Diseases of Vojvodina, Clinic for Cardiovascular Surgery, 17 ministernotomies were performed, with 14 aortic valve replacements (82.35%) and 3 mitral valve replacements (17.65%). Mean age of the patients was 60.78 ? 12.99 years (64.71% males, 35.29% females). Mean extubation time was 12.53 ? 8.87 hours with 23.5% of the patients extubated in less than 8 hours. Mean duration of hospital stay was 12.35 ? 10.17 days (in 29.4% of the patients less than 8 days). Mean postoperative drainage was 547.06 ? 335.2 mL. Postoperative complications included: bleeding (5.88%) and cerebrovascular insult (5.88%). One patient (5.88%) required conversion to full sternotomy. Conclusion. Partial upper median sternotomy represents the optimal surgical method for the interventions on the whole ascendant aorta (including aortic valve) and mitral valve through the roof of the left atrium, with a few significant advantages compared to the full sternotomy surgical approach.

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