scholarly journals Learning Curve from 100 Cases of Totally Thoracoscopic Mitral Valve Replacement

2021 ◽  
Vol 24 (5) ◽  
pp. E882-E886
Author(s):  
Guan-hua Fang ◽  
Jin-hua Chen ◽  
Xiao-fu Dai
Keyword(s):  
Mitral Valve ◽  
Learning Curve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Skill Acquisition ◽  
Median Sternotomy ◽  
Oxygenation Index ◽  
Cumulative Sum ◽  
Cumulative Sum Analysis ◽  
Significant Difference

Background: To investigate and analyze the learning curve of totally thoracoscopic mitral valve replacement and provide a quantitative reference for cardiac surgeons to carry out the operation step by step. Methods: The clinical data were retrospectively analyzed of 100 consecutive patients with totally thoracoscopic mitral valve replacement successively performed by the same surgeon in a single center from May 2019 to June 2020. The learning curve was divided into 2 stages by using cumulative sum analysis, and relevant surgical parameters and perioperative indicators were analyzed. Results: The first stage of the learning curve is the skill acquisition stage, which includes 1 to 40 surgical procedures. The second stage is the proficiency stage, involving 41 to 100 operations. Among the surgical parameters of the patients in the 2 stages, detectable improvements were observed in operative time, cardiopulmonary bypass time, cross-clamp time, and intraoperative injury. After surgery, the amount of drainage, length of hospital stay, blood creatinine levels, and oxygenation index 24 h after surgery were also significantly different between the 2 groups (all P < .05). The age and sex distributions of the patients were balanced, and there was no statistically significant difference in terms of conversion to median sternotomy between the 2 stages (P > .05). Conclusions: Cumulative sum analysis was used to accurately analyze the learning curve of totally thoracoscopic mitral valve replacement, indicating that 40 cases are needed to master the technique.

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 Evaluation of the preoperative administration of sildenafil on operative and early postoperative outcome after mitral valve replacement in patients with pulmonary hypertension

2020 ◽  
Author(s):  
Islam M Ibrahim ◽  
Ahmed L Dokhan ◽  
Rasha S Elsebaey ◽  
Mohammed G Abdellatif
Keyword(s):  
Pulmonary Hypertension ◽  
Mitral Valve ◽  
Pulmonary Artery ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Systolic Pulmonary Artery Pressure ◽  
Preoperative Administration ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background: Mitral valve diseases are commonly associated with pulmonary hypertension. The aim of this study was to evaluate the effect of preoperative administration of sildenafil on the outcome after mitral valve replacement in patients with pulmonary hypertension. Methods: This prospective randomized study was carried out on 67 patients who had a mitral valve replacement and associated high systolic pulmonary artery pressure more than 50 mmHg. Patients were randomized into three groups: group A (n= 20) received preoperative sildenafil for one week, group B (n=22) received sildenafil for one month, and group C (n= 25) did not receive sildenafil. All patients had transthoracic echocardiography preoperatively, one week and one month postoperatively. Results: There was no difference in preoperative and operative variables among groups. Dobutamine support was required in 15 patients (60%) in group C vs. 6 patients (30%) in group A and 5 patients (22.5%) in group B (p= 0.012). Duration of mechanical ventilation was significantly longer in group C (389.2 ± 48.79 minutes) compared to group A and B (295.5 ± 17.01 and 281.4 ± 39.44 minutes, respectively, p<0.001). ICU stay was longer in group C (61.72 ± 13.69 hours) compared to groups A and B (53.55 ± 14.49 and 45.64 ± 13.43 hours, respectively, p=0001). The hospital stay was longer in group C (8.0 ± 1.80 days) compared to group A and B (6.05 ± 0.94 and 6.27 ± 1.24 days, respectively; p< 0.001). The transthoracic echocardiographic study one month after the operation showed that pulmonary artery systolic pressure significantly lower in groups A and B (28.30 ± 3.3 and 28.2 ± 4.98 mmHg, respectively) compared to group C (43.12 ± 4.99 mmHg) (p <0.001). There was no statistically significant difference between groups A and B regarding PASP after five days  (p= 0.287) or one month (p= 0.939). Conclusion: We found that preoperative administration of oral sildenafil in patients with pulmonary hypertension undergoing mitral valve replacement may reduce pulmonary hypertension postoperatively. We could not find a difference in the administration of sildenafil for either one week or one month preoperatively.

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.

scholarly journals Early outcome of mitral valve replacement through right anterolateral thoracotomy versus standard median sternotomy

2018 ◽  
Vol 11 (1) ◽  
pp. 94
Author(s):  
Heemel Saha ◽  
Redoy Ranjan ◽  
Dipannita Adhikary ◽  
Jubayer Ahmed ◽  
Sanjoy Kumar Saha ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Median Sternotomy ◽  
Wound Dehiscence ◽  
Study Groups ◽  
Sitting Posture ◽  
Anterolateral Thoracotomy ◽  
Group I ◽  
Group Ii

<p class="Abstract">This study was aimed to compare the peri-operative outcomes among the mitral valve replace-ment using anterolateral thoracotomy (n=17) and standard median sternotomy (n=17) in a single surgeons practice. The mean age was 24.1 ± 5.3 years in Group I and 41.0 ± 11.5 years in Group II. Female was predominant in Group I. Total operative time and bypass time were significant in both the study groups. Incision scar was not visible in females in Group I but full incision scar was visible in Group II in sitting posture. In Group I patients, majority (52.9%) patients needed short duration of ICU stay in comparison to Group II, and the difference was statistically significant (p&lt;0.05) between the two groups. During discharge, 94.1% wound was well healed in Group I and 70.6% in Group II. Wound dehiscence was nil in Group I, but 23.5% patients developed dehiscence in Group II. However, only 5.9% patient developed unstable sternum in Group II. Cosmetic mitral valve replacement can be done safely through anterolateral thoracotomy and it is cost effective especially for the developing countries.</p>

scholarly journals Short Term Clinical Outcome in Patients with Mitral Valve Replacement with or without Preservation of Subvalvular Apparatus

2017 ◽  
Vol 12 (1) ◽  
pp. 3-7
Author(s):  
Sabrina Sharmeen Husain ◽  
Chaudhury Meshkat Ahmed ◽  
Arif Mohmmad Sohan ◽  
Sohel Mahmud ◽  
Md Mustafizur Rahman ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Age Distribution ◽  
Left Ventricular ◽  
Hospital Death ◽  
P Value ◽  
Group I ◽  
Significant Difference ◽  
Group Ii

Background: Preservation of subvalvular apparatus (SAP) during mitral valve replacement (MVR) was introduced about forty years back, but the outcome of this procedure is not well studied yet. Our study aimed to measure the in-hospital outcome of this procedure in rheumatic patients.Method: 44 patients of rheumatic heart disease undergoing for MVR in the department of cardiac surgery, BSMMU were enrolled for the study. The technique of SAP was according to choice of surgeon. Patients were divided into two groups- I) with preservation: complete preservation, where entire chordo-papillary apparatus was preserved & partial preservation, where posterior leaflet was preserved, II) no preservation: where subvalvular apparatus was completely excised. Surgical technique was different according to patient’s requirement and one of either technique was adopted by Fuster et al or Miki et al. Patients’ demographic profile and mitral valve status were recorded. Outcome was recorded in terms of hemoynamic outcome and in hospital death. Data was analyzed by Chi squired test.Result: Mean±SD of age of patients was 32±8 years, 29±7years in group-I, 36±9years in group-II. There was no significant difference in age distribution between two groups. Both groups were female predominant, 82% in group-I and 73% in group-II. Low cardiac output syndrome was observed in 4.5% of group-I and 32% in group-II (P-value was <0.001). Left ventricular failure was observed as 0% & 32% respectively (p value was <0.001). Inotropic agent was needed 45% & 75% respectively (p value was <0.01). In hospital death occurred in 4.5% & 13.5% in two groups respectively with no significant difference.Conclusion: Hemodynamic outcome and in hospital mortality was better when subvalvular apparatus was preserved during mitral valve replacement in rheumatic population.University Heart Journal Vol. 12, No. 1, January 2016; 3-7

scholarly journals Early clinical outcome after right anterolateral thoracotomy as an alternative for median sternotomy for mitral valve replacement

2020 ◽  
Vol 2 (2) ◽  
pp. 47-54
Author(s):  
Ahmed Rady Attallah ◽  
Shady Eid Al-Elwany ◽  
Mohammed A.K. Salama Ayyad ◽  
Ali Mohammed Abdelwahab
Keyword(s):  
Mitral Valve ◽  
Blood Transfusion ◽  
Clinical Outcome ◽  
Blood Loss ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Median Sternotomy ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Anterolateral Thoracotomy

Background: The advantages of the right anterolateral thoracotomy (RALT) approach for mitral valve surgery over standard median sternotomy (MS) are still debatable. The objective of this study was to evaluate and compare the postoperative clinical outcome after RALT and MS for mitral valve replacement. Methods: This prospective observational study included 40 patients who underwent mitral valve replacement between January 2016 and August 2018. Patients were assigned to two groups, the first group included 20 patients who had conventional median sternotomy approach and the second group included 20 patients who had right anterolateral thoracotomy with the complete cannulation and aortic cross-clamping conducted through the same incision. Results: In comparison to MS, RALT had significantly higher cross-clamp time (77.7±16.1 vs 45.8±8.7 minutes, P < 0.01), total bypass time (105.2±12.7 vs 72.2±10.4 minutes, P < 0.01), and total operative time (287±41 vs 231±36 min, P < 0.01), in addition to significantly lower ventilation time (4.2±1.51 vs 6.1±1.84 hours, P < 0.01), blood loss (229±85 vs 335±137 ml), amount of blood transfusion (1.41±0.6 vs 2.19±1.1 units, P < 0.01), ICU stay duration (2.11±0.49 vs 2.78±0.82 days, P < 0.01), pain scores at 1st and 2nd postoperative days (5.67±0.79 vs 7.81±0.53, p < 0.01), and total hospital stay duration (7.2±1.3 vs 8.4±1.6 days, P = 0.01). Patients' satisfaction about their wound was significantly higher in RALT group compared to MS group (95% vs 30%, P < 0.01). Conclusion: The RALT approach for mitral valve surgery could be a safe and effective approach when compared to median sternotomy. RALT could be associated with a reduction of blood loss, blood transfusion, wound infection, in addition to shorter ICU and hospital stay.

scholarly journals Beating-heart versus conventional mitral valve replacement; a randomized clinical trial

2020 ◽  
Author(s):  
Abd-Allah Badr ◽  
Essam Yousef ◽  
Mostafa Kotb ◽  
Ahmed Deebis
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Troponin I ◽  
Conventional Technique ◽  
Beating Heart ◽  
Control Group ◽  
Coronary Perfusion ◽  
Significant Difference ◽  
Heart Group

Background: Various methods have been developed to overcome the deleterious effects of ischemia/ reperfusion injury that occurs after cardioplegic arrest. The aim of the study was to assess the safety, efficacy, and applicability of the beating-heart mitral valve replacement (MVR) compared to the conventional MVR. Methods: Forty patients scheduled for mitral valve replacement were randomly assigned into two groups, conventional MVR as the control group (n= 20) and beating-heart MVR with continuous antegrade coronary perfusion as the study group (n=20). Three patients in the beating-heart group were converted to the conventional technique because of the blood-flooded field and excluded from the analysis. Results: The preoperative clinical and echocardiographic variables were comparable between both groups. There was no significant difference between both groups regarding cardiopulmonary bypass time (79.4± 14 vs. 75.7± 10.9 minutes; p= 0.398) and total operative time (200± 55.6 vs. 183.9± 67.5 min; p= 0.458) in the conventional and beating-heart group, respectively. Serum troponin I level was significantly higher in the conventional MVR group 6 hours postoperatively (4.9±4 vs. 2.7±1.2 ng/ml; p= 0.036), while there was no significant difference between both groups regarding total CK and CK-MB (p= 0.565 & 0.597 respectively).  Eight patients (44%) in the conventional MVR group needed inotropic support compared to 3 patients (19%) in the beating-heart MVR group (P = 0.11). There was no operative mortality or major morbidity in both groups. At 6-months follow-up, there was no difference in NYHA class (1.3±0.3 vs. 1.2±0.3; p= 0.336) and the ejection fraction (60.0±6.3 vs. 63.2±6 %; p= 0.139) in the conventional vs. beating-heart group.  Conclusion: Beating-heart MVR is a safe alternative to the conventional method with comparable outcomes. There is a relatively blood-filled field compared to the conventional technique.

scholarly journals Mitral Valve Replacement Using Subvalvular Apparatus: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 23 (3) ◽  
pp. E385-E392
Author(s):  
Wan Chin Hsieh ◽  
Anas Aboud ◽  
Brandon Michael Henry ◽  
Chung Dann Kan ◽  
Mohamed Omara ◽  
...  
Keyword(s):  
Renal Failure ◽  
Mitral Valve ◽  
Length Of Stay ◽  
Clinical Outcomes ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Meta Analysis ◽  
Significant Difference ◽  
Long Term Mortality

Background: To assess clinical outcomes among participants undergoing mitral valve replacement with preservation of subvalvular apparatus. Methods: Electronic databases, including PubMed, Embase, Science Direct, World of Science, Scopus, Biosis, SciElo and Cochrane library, were probed using an extensive search strategy. Studies that reported at least one clinical outcome, such as morbidity, mortality, early 30-day mortality, myocardial failure, survival, late cerebrovascular events, length of stay, or major operative complications (stroke, prolonged ventilation, and reoperation for bleeding, renal failure, and sternal infection) were considered for inclusion. Data was extracted and pooled into a meta-analysis in RevMan (version 5.3) using a random-effects model. Results: A total of 21 studies with 5,106 participants (age range: 27.3-69.2 years) were included in this meta-analysis. Preservation of the subvalvular apparatus during MVR significantly reduces the risk of long-term mortality (OR: 0.46; 95% CI: 0.33-0.64), but not early mortality (OR: 0.76; 95% CI: 0.12-4.93). No significant difference ejection fraction was observed (SMD: 0.10; 95% CI: -0.44-0.64). Similarly, there was no significant difference in the risk of stroke, renal failure, and pneumonia between C-MVR and in the control group. Conclusion: MVR with the preservation of subvalvular apparatus improves clinical outcomes, such as long-term mortality, hospital length of stay, pneumonia, and bleeding. There is no significant difference in the risk of stroke, renal failure, or ICU length of stay. However, there is very limited data available with respect to bleeding, sepsis, and nosocomial infections.

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