Minimally Invasive Mitral Valve Surgery I

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Abstract

Widespread adoption of minimally invasive mitral valve repair and replacement may be fostered by practice consensus and standardization. This expert opinion, first of a 3-part series, outlines current best practices in patient evaluation and selection for minimally invasive mitral valve procedures, and discusses preoperative planning for cannulation and myocardial protection.

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Most cited references 24

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Minimally invasive cardiac valve surgery improves patient satisfaction while reducing costs of cardiac valve replacement and repair.

S Aranki, D Rosborough, G Couper … (1997)

This study compares the quality of valve replacement and repair performed through minimally invasive incisions as compared to the standard operation for aortic and mitral valve replacement. With the advent of minimally invasive laparoscopic approaches to orthopedic surgery, urology, general surgery, and thoracic surgery, it now is apparent that standard cardiac valve operations can be performed through very small incisions with similar approaches. Eighty-four patients underwent minimally invasive aortic (n = 41) and minimally invasive mitral valve repair and replacement (n = 43) between July 1996 and April 1997. Demographics, procedures, operative techniques, and postoperative morbidity and mortality were calculated, and a subset of the first 50 patients was compared to a 50-patient cohort who underwent the same operation through a conventional median sternotomy. Demographics, postoperative morbidity and mortality, patient satisfaction, and charges were compared. Of the 84 patients, there were 2 operative mortalities both in class IV aortic patients from multisystem organ failure. There was no operative mortality in the patients undergoing mitral valve replacement or repair. The operations were carried out with the same accuracy and attention to detail as with the conventional operation. There was minimal postoperative bleeding, cerebral vascular accidents, or other major morbidity. Groin cannulation complications primarily were related to atherosclerotic femoral arteries. A comparison of the minimally invasive to the conventional group, although operative time and ischemia time was higher in minimally invasive group, the requirement for erythrocytes was significantly less, patient satisfaction was significantly greater, and charges were approximately 20% less than those in the conventional group. Minimally invasive aortic and mitral valve surgery in patients without coronary disease can be done safely and accurately through small incisions. Patient satisfaction is up, return to normality is higher, and requirement for postrehabilitation services is less. In addition, the charges are approximately 20% less. These results serve as a paradigm for the future in terms of valve surgery in the managed care environment.

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J. Maxwell Chamberlain Memorial Paper for adult cardiac surgery. Less-invasive mitral valve operations: trends and outcomes from the Society of Thoracic Surgeons Adult Cardiac Surgery Database.

James S Gammie, Yue Zhao, Eric D Peterson … (2010)

The purpose of this study was to examine utilization and outcomes of less-invasive mitral valve (LIMV) operations in North America. Between 2004 and 2008, 28,143 patients undergoing isolated mitral valve (MV) operations were identified in The Society of Thoracic Surgeons Adult Cardiac Surgical Database (STS ACSD). The LIMV operations were defined as those performed with femoral arterial and venous cannulation. The LIMV operations increased from 11.9% of MV operations in 2004 to 20.1% in 2008 (p < 0.0001). In 2008, 26% of STS ACSD centers performed at least one LIMV operation, with a median of 3 per year. Patients in the LIMV group were younger and had fewer comorbidities. Median perfusion (135 versus 108 minutes) and cross-clamp times (100 versus 80 minutes, p < 0.0001) were longer in the LIMV group. Mitral valve repair rates were higher in the LIMV group (85% versus 67%, p < 0.0001). Adjusted operative mortality was similar (odds ratio 1.13, 95% confidence interval: 0.84 to 1.51, p = 0.47). Blood transfusion was less common (odds ratio 0.86, 95% confidence interval: 0.76 to 0.97, p < 0.0001) while stroke was more common (OR 1.96, 95% confidence interval: 1.46 to 2.63, p < 0.0001) in the LIMV group. In selected patients, LIMV operations can be performed with equivalent operative mortality, shorter hospital stay, fewer blood transfusions, and higher rates of MV repair than conventional sternotomy. However, perfusion and cross-clamp times were longer, and the risk of stroke was significantly higher. Beating- or fibrillating-heart LIMV techniques are associated with particularly high risks for perioperative stroke. Copyright © 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

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Minimally invasive valve operations.

Delos Cosgrove, Joseph F Sabik, Jose L. Navia (1998)

To reduce the morbidity from valvular heart operations, a right parasternal approach was introduced. We report our initial experience with the procedure. From January 1996 through July 1996, 115 patients underwent primary isolated valve procedures. One hundred (85%) patients underwent the operation through a right parasternal incision. There was one hospital death secondary to a stroke on the fifth postoperative day. Three patients (two with aortic valve operations and one having a mitral valve procedure) required conversion to sternotomy. Mean aortic occlusion time was 71 minutes; mean cardiopulmonary bypass time was 93 minutes. Mean stay in the intensive care unit was 27 hours and mean hospital postoperative stay was 5.7 days. Seventy-seven percent of the patients did not receive blood transfusions. Comparison with median sternotomy demonstrated a reduction in both postoperative length of stay and direct hospital costs. We conclude that this minimally invasive approach is safe for a variety of valve procedures and is effective in reducing surgical trauma and cost.

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Author and article information

Journal

Journal ID (nlm-ta): Innovations (Phila)

Journal ID (iso-abbrev): Innovations (Phila)

Journal ID (publisher-id): ITT

Title: Innovations (Philadelphia, Pa.)

Publisher: Lippincott Williams & Wilkins

ISSN (Print): 1556-9845

ISSN (Electronic): 1559-0879

Publication date (Print): July 2016

Publication date (Electronic): 20 September 2016

Volume: 11

Issue: 4

Pages: 243-250

Affiliations

[1]From the *University of Virginia, Charlottesville, VA USA; †Saint Elizabeth's Medical Center, Brighton, MA USA; ‡Penrose St. Francis Hospital, Colorado Springs, CO USA; §Northeast Georgia Physicians Group, Gainesville, GA USA; ∥Gulf Coast Cardiothoracic and Vascular Surgeons, Ft. Myers, FL USA; ¶Holy Spirit Northside Hospital, Chermside, Australia; #Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN USA; **New York University School of Medicine, New York, NY USA; ††Temple University, Philadelphia, PA USA; ‡‡Penn Presbyterian Medical Center, Philadelphia, PA USA; §§East Bay Cardiac Surgery Center, Oakland, CA USA; ∥∥Swedish Heart and Vascular Institute, Seattle, WA USA; ¶¶Northwestern University, Feinberg School of Medicine, Chicago, IL USA; ##Emory St. Joseph's Hospital, Atlanta, GA USA; ***St. Thomas Hospital, Nashville, TN USA; †††The Heart Hospital Baylor Plano, Plano, TX USA; ‡‡‡Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY USA; §§§South Florida Heart & Lung Institute, Doral, FL USA; ∥∥∥David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA USA; ¶¶¶TriHealth Heart Institute, Cincinnati, OH USA; ###Central Maine Heart and Vascular Institute, Lewiston, ME USA; ****Lankenau Medical Center, Wynnewood, PA USA; and ††††Department of Cardiothoracic Surgery, Princeton Baptist Hospital, Birmingham, AL USA.

Author notes

Address correspondence and reprint requests to Glenn R. Barnhart, MD, Swedish Heart and Vascular Institute, 1600 E. Jefferson, Suite 110, Seattle, WA 98122 USA. E-mail: glenn.barnhart@ 123456swedish.org .

Article

Publisher ID: ITT50159 Accession ID: 00003

DOI: 10.1097/IMI.0000000000000301

PMC ID: 5051530

PubMed ID: 27654407

SO-VID: d1b15cd2-84c7-4769-a470-bf007b79a3ce

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.

History

Date accepted : 16 June 2016

Page count

Pages: 0

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Keywords: minimally invasive surgery (includes port access, minithoracotomy),mitral valve, repair, replacement,surgery/incisions/exposure/techniques,mvr, mimvr,heart valve

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Keywords: minimally invasive surgery (includes port access, minithoracotomy), mitral valve, repair, replacement, surgery/incisions/exposure/techniques, mvr, mimvr, heart valve

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Minimally Invasive Mitral Valve Surgery I : Patient Selection, Evaluation, and Planning

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SICOT-J (Orthopedic surgery and traumatology)

Most cited references 24

Minimally invasive cardiac valve surgery improves patient satisfaction while reducing costs of cardiac valve replacement and repair.

J. Maxwell Chamberlain Memorial Paper for adult cardiac surgery. Less-invasive mitral valve operations: trends and outcomes from the Society of Thoracic Surgeons Adult Cardiac Surgery Database.

Minimally invasive valve operations.

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Cited by 9

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