Minimally Invasive Mitral Valve Surgery Utilizing Heart Port Technology. Issue 3 (4th February 2014)

• Record Type: Journal Article
• Authors: Vallabhajosyula, Prashanth; Wallen, Tyler J.; Solometo, Lauren P.; Fox, Jeanne; Vernick, William J.; Hargrove, W. Clark
• Is Part Of: Journal of cardiac surgery. Volume 29:Issue 3(2014:May)
• Page Start: 343
• Page End: 348
• Publication Date: 2014-02-04
• Subjects: Heart -- Surgery -- Periodicals; 617.412005
• DOI: 10.1111/jocs.12293
• Languages: English
• ISSNs: 0886-0440

Abstract

<abstract abstract-type="main" xml:lang="en"> <title>Abstract</title> <sec id="jocs12293-sec-0001" sec-type="section"> <title>Objective</title> <p>To determine operative outcomes of right mini‐thoracotomy mitral valve surgery utilizing port access technology in first‐time and reoperative cardiac surgery patients.</p> </sec> <sec id="jocs12293-sec-0002" sec-type="section"> <title>Methods</title> <p>From 2002 to 2011, 881 patients underwent minimally invasive mitral valve surgery. Of these, 154 patients had previous cardiac operations via sternotomy (Group 1), of which 18 (12%) had two previous operations. Seven hundred and twenty‐seven patients had no previous cardiac operations (Group 2).</p> </sec> <sec id="jocs12293-sec-0003" sec-type="section"> <title>Results</title> <p>Patient demographics were similar in both groups. In Group 1, 76 (49%) patients had previous coronary artery bypass grafting, 13 (8%) had previous aortic valve surgery, and 57 (37%) had previous mitral valve surgery. Preoperative echo findings for Groups 1 and 2 included severe mitral regurgitation (MR) (88%, n = 135; 94%, n = 687), mitral stenosis (MS) (4%, n = 6; 2%, n = 12), MS + MR (8%, n = 13; 4%, n = 28), and ejection fraction (48%, 56%). Operative procedures in Groups 1 and 2 were MV repair (54%, n = 84; 89%, n = 645) and MV replacement (46%, n = 70; 11%, n = 82). Circulatory management techniques for Groups 1 and 2 included endoballoon (75%, n = 116; 79%, n = 576), Chitwood clamp (8%, n = 12; 20%, n = 147), and fibrillatory arrest (17%, n = 30; 0.5%, n = 4). Perioperative outcomes were: stroke: 2.5%, 1.6%; reoperation for bleeding: 5%, 6%; valvular reoperation rate: 0.6%, 2%; aortic dissection: 2.5%, 1%; and wound infection: 0%, 0%. Transfusion requirement was 49% (n = 76) and 31% (n = 232), respectively. Median hospital stay was seven and seven days, respectively. On postoperative echocardiography, 98% (n = 151) and 99% (n = 718) of patients had zero or trace MR (1+) with 100% freedom from MR > 2+. In‐hospital mortality was 3% (n = 5) and 1% (n = 8).</p> </sec> <sec id="jocs12293-sec-0004" sec-type="section"> <title>Conclusions</title> <p>Operative outcomes with minimally invasive mitral valve surgery utilizing port access technology can be performed safely. Stroke rate was higher in the reoperative cases (p = NS) although similar to reports evaluating redo sternotomy in mitral valve cases. doi: 10.1111/jocs.12293 <italic>(J Card Surg 2014;29:343–348)</italic></p> </sec> </abstract>