CC BY-NC-ND 4.0 · Thorac Cardiovasc Surg Rep 2019; 08(01): e37-e40
DOI: 10.1055/s-0039-1700881
Case Report: Cardiac
Georg Thieme Verlag KG Stuttgart · New York

An 86-Year-Old Female with Mitral Regurgitation and Significant Pectus Excavatum

Raphael Tasar
1   Department of Cardiothoracic Surgery, University Hospital Jena, Jena, Germany
,
Sophie Tkebuchava
1   Department of Cardiothoracic Surgery, University Hospital Jena, Jena, Germany
,
Mahmoud Diab
1   Department of Cardiothoracic Surgery, University Hospital Jena, Jena, Germany
,
Torsten Doenst
1   Department of Cardiothoracic Surgery, University Hospital Jena, Jena, Germany
› Author Affiliations
Further Information

Publication History

11 June 2019

30 July 2019

Publication Date:
13 December 2019 (online)

Abstract

Background We report the case of minimally invasive mitral valve repair in an 86-year-old female with symptomatic structural mitral regurgitation and severe pectus excavatum.

Case Description The case summarizes four areas of repetitive heart team discussions. First, should an 86-year-old patient still be treated invasively? Second, if so, should treatment be interventional or surgical? Third, if surgical, should we replace or repair at that age and fourth which surgical access is best with respect to her chest deformation?

Conclusion We chose to surgically repair the valve using a minimally invasive approach. The patient was extubated 3 hours after surgery and discharged after 7 days.

 
  • References

  • 1 Moschovas A, Amorim PA, Nold M. , et al. Percutaneous cannulation for cardiopulmonary bypass in minimally invasive surgery is associated with reduced groin complications. Interact Cardiovasc Thorac Surg 2017; 25 (03) 377-383
  • 2 Iung B, Cachier A, Baron G. , et al. Decision-making in elderly patients with severe aortic stenosis: why are so many denied surgery?. Eur Heart J 2005; 26 (24) 2714-2720
  • 3 Wang W, Bagshaw SM, Norris CM, Zibdawi R, Zibdawi M, MacArthur R. ; APPROACH Investigators. Association between older age and outcome after cardiac surgery: a population-based cohort study. J Cardiothorac Surg 2014; 9: 177
  • 4 Zingone B, Gatti G, Rauber E. , et al. Early and late outcomes of cardiac surgery in octogenarians. Ann Thorac Surg 2009; 87 (01) 71-78
  • 5 Faerber G, Doenst T. Cardiac (valve) surgery in the elderly-who decides you are too old?. J Thorac Cardiovasc Surg 2018; 155 (04) 1461-1462
  • 6 O'Gara PT, Grayburn PA, Badhwar V. , et al. 2017 ACC Expert Consensus Decision Pathway on the Management of Mitral Regurgitation: a report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways. J Am Coll Cardiol 2017; 70 (19) 2421-2449
  • 7 Suri RM, Clavel MA, Schaff HV. , et al. Effect of recurrent mitral regurgitation following degenerative mitral valve repair: long-term analysis of competing outcomes. J Am Coll Cardiol 2016; 67 (05) 488-498
  • 8 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
  • 9 Mick SL, Keshavamurthy S, Gillinov AM. Mitral valve repair versus replacement. Ann Cardiothorac Surg 2015; 4 (03) 230-237
  • 10 Silaschi M, Chaubey S, Aldalati O. , et al. Is mitral valve repair superior to mitral valve replacement in elderly patients? Comparison of short- and long-term outcomes in a propensity-matched cohort. J Am Heart Assoc 2016; 5 (08) e003605
  • 11 Takagi H, Ando T, Umemoto T. Direct and adjusted indirect comparisons of perioperative mortality after sutureless or rapid-deployment aortic valve replacement versus transcatheter aortic valve implantation. Int J Cardiol 2017; 228: 327-334
  • 12 Doenst T, Lamelas J. Do we have enough evidence for minimally-invasive cardiac surgery? A critical review of scientific and non-scientific information. J Cardiovasc Surg 2017; 58: 613-623
  • 13 Mihaljevic T, Koprivanac M, Kelava M. et al. Value of Robotically Assisted Surgery for Mitral Valve DiseaseRobotically Assisted Mitral Valve SurgeryRobotically Assisted Mitral Valve Surgery. JAMA Surgery 2014; 149: 679-686