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Thorac Cardiovasc Surg 2020; 68(06): 462-469
DOI: 10.1055/s-0039-1692403
Original Cardiovascular

Minithoracotomy and Beating Heart Strategy for Mitral Surgery in Secondary Mitral Regurgitation

Daniel Grinberg 
1   Department of Adult Cardiac Surgery, Hôpital Cardiologique Louis Pradel, Lyon Medical School, Lyon, France
2   Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
4   Sinai Biodesign and department of neurosurgery at Icahn School of Medicine and Mount Sinai Health system, New York, New York
,
Matteo Pozzi
1   Department of Adult Cardiac Surgery, Hôpital Cardiologique Louis Pradel, Lyon Medical School, Lyon, France
,
Marine Bordet
1   Department of Adult Cardiac Surgery, Hôpital Cardiologique Louis Pradel, Lyon Medical School, Lyon, France
,
Kaled Adamou Nouhou
1   Department of Adult Cardiac Surgery, Hôpital Cardiologique Louis Pradel, Lyon Medical School, Lyon, France
,
Young Joon Kwon
4   Sinai Biodesign and department of neurosurgery at Icahn School of Medicine and Mount Sinai Health system, New York, New York
,
Jean-François Obadia
1   Department of Adult Cardiac Surgery, Hôpital Cardiologique Louis Pradel, Lyon Medical School, Lyon, France
,
Marco Vola
1   Department of Adult Cardiac Surgery, Hôpital Cardiologique Louis Pradel, Lyon Medical School, Lyon, France
3   Department of Cardiovascular Surgery, Saint-Etienne Medical School, Saint-Etienne, France
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Abstract

Background In patients with secondary mitral regurgitation (MR) associated with low ejection fraction or previous heart surgery, minimally invasive mitral valve surgery without aortic cross-clamp (MIMVS-WAC) has shown promising results. We report our experience for this strategy in our centers.

Methods Between August 2011 and April 2017, 46 patients (mean age 69 ± 11 years, 76% males) received MIMVS-WAC. Indications for this technique were prior coronary bypass surgery (26%), severe or recent left ventricular (LV) dysfunction (30%), or both (39%). The mean EuroSCORE II was 12 ± 10.

Results For each procedure, we conducted right minithoracotomy and hypothermic cardiopulmonary bypass (CPB) after peripheral cannulation. Mean CPB time was 159 ± 39 minutes. A mitral valve replacement (MVR) was performed in 23 cases (50%), an annuloplasty in 22 cases (48%), and a prosthesis pannus removal in 1 case (2%). Mean hospital length of stay was 12 ± 5.4 days. We report no sternotomy conversions, six reoperations for bleeding, and three deaths at 30 days. Transfusion was requested in 62% (mean infusion 2 ± 2.4 packed red blood cells). The postoperative echocardiography showed an LV function preservation in 69% of cases and a reduction of pulmonary arterial pressure in 73% of cases. Four additional deaths occurred in the long-term follow-up (mean 637 ± 381 days, median 593 days). No mitral reoperation was required, with a MR ≤ 2 in 90% of patients.

Conclusion In high-risk patients, the MIMVS-WAC is a safe technique. It avoids hard dissections while ensuring excellent preservation of cardiac function.

Keywords

mitral valve surgery - minimally mitral invasive surgery - beating heart - high risk surgery

Note

There is no meeting presentation.




Publication History

Received: 30 January 2019

Accepted: 25 April 2019

Article published online:
26 June 2019

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Stuttgart · New York

 

  • References

  • 1 Sündermann SH, Czerny M, Falk V. Open vs. minimally invasive mitral valve surgery: surgical technique, indications and results. Cardiovasc Eng Technol 2015; 6 (02) 160-166
    CrossrefPubMedGoogle Scholar
  • 2 Ghoneim A, Bouhout I, Mazine A. , et al. Beating heart minimally invasive mitral valve surgery in patients with patent coronary bypass grafts. Can J Cardiol 2016; 32 (08) 987.e1-987.e6
    CrossrefPubMedGoogle Scholar
  • 3 Xu RB, Rahnavardi M, Nadal M. , et al. Beating heart minimally invasive mitral valve surgery in patients with previous sternotomy: the operative technique and early outcomes. Open Heart 2018; 5 (01) e000749
    CrossrefPubMedGoogle Scholar
  • 4 Cao H, Zhou Q, Fan F, Xue Y, Pan J, Wang D. Right anterolateral thoracotomy: an attractive alternative to repeat sternotomy for high-risk patients undergoing reoperative mitral and tricuspid valve surgery. J Cardiothorac Surg 2017; 12 (01) 85
    CrossrefPubMedGoogle Scholar
  • 5 Hiraoka A, Kuinose M, Totsugawa T, Chikazawa G, Yoshitaka H. Mitral valve reoperation under ventricular fibrillation through right mini-thoracotomy using three-dimensional videoscope. J Cardiothorac Surg 2013; 8: 81
    CrossrefPubMedGoogle Scholar
  • 6 Milani R, Brofman PR, Oliveira S. , et al. Minimally invasive redo mitral valve surgery without aortic crossclamp. Rev Bras Cir Cardiovasc 2013; 28 (03) 325-330
    CrossrefPubMedGoogle Scholar
  • 7 Pasic M, Sündermann S, Unbehaun A, Kempfert J, Jacobs S, Falk V. Beating heart mitral valve surgery: results in 120 consecutive patients considered unsuitable for conventional mitral valve surgery. Interact Cardiovasc Thorac Surg 2017; 25 (04) 541-547
    CrossrefPubMedGoogle Scholar
  • 8 Holzhey DM, Seeburger J, Misfeld M, Borger MA, Mohr FW. Learning minimally invasive mitral valve surgery: a cumulative sum sequential probability analysis of 3895 operations from a single high-volume center. Circulation 2013; 128 (05) 483-491
    CrossrefPubMedGoogle Scholar
  • 9 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
    CrossrefPubMedGoogle Scholar
  • 10 Botta L, Cannata A, Bruschi G. , et al. Minimally invasive approach for redo mitral valve surgery. J Thorac Dis 2013; 5 (Suppl. 06) S686-S693
    PubMedGoogle Scholar
  • 11 Garbade J, Seeburger J, Merk DR. , et al. Mitral valve pathology in severely impaired left ventricles can be successfully managed using a right-sided minimally invasive surgical approach. Eur J Cardiothorac Surg 2013; 44 (01) e1-e7
    CrossrefPubMedGoogle Scholar
  • 12 Goldstein D, Moskowitz AJ, Gelijns AC. , et al; CTSN. Two-year outcomes of surgical treatment of severe ischemic mitral regurgitation. N Engl J Med 2016; 374 (04) 344-353
    CrossrefPubMedGoogle Scholar
  • 13 Murzi M, Miceli A, Di Stefano G. , et al. Minimally invasive right thoracotomy approach for mitral valve surgery in patients with previous sternotomy: a single institution experience with 173 patients. J Thorac Cardiovasc Surg 2014; 148 (06) 2763-2768
    CrossrefPubMedGoogle Scholar
  • 14 Vassileva CM, Boley T, Markwell S, Hazelrigg S. Meta-analysis of short-term and long-term survival following repair versus replacement for ischemic mitral regurgitation. Eur J Cardiothorac Surg 2011; 39 (03) 295-303
    CrossrefPubMedGoogle Scholar
  • 15 Mihos CG, Santana O. Mitral valve repair for ischemic mitral regurgitation: lessons from the Cardiothoracic Surgical Trials Network randomized study. J Thorac Dis 2016; 8 (01) E94-E99
    PubMedGoogle Scholar
  • 16 Maltais S, Schaff HV, Daly RC. , et al. Mitral regurgitation surgery in patients with ischemic cardiomyopathy and ischemic mitral regurgitation: factors that influence survival. J Thorac Cardiovasc Surg 2011; 142 (05) 995-1001
    CrossrefPubMedGoogle Scholar
  • 17 Calafiore AM, Iacò AL, Gallina S, Al-Amri H, Penco M, Di Mauro M. Surgical treatment of functional mitral regurgitation. Int J Cardiol 2013; 166 (03) 559-571
    CrossrefPubMedGoogle Scholar
  • 18 Cheng DC, Martin J, Lal A. , et al. Minimally invasive versus conventional open mitral valve surgery: a meta-analysis and systematic review. Innovations (Phila) 2011; 6 (02) 84-103
    CrossrefPubMedGoogle Scholar
  • 19 Ding C, Jiang DM, Tao KY. , et al. Anterolateral minithoracotomy versus median sternotomy for mitral valve disease: a meta-analysis. J Zhejiang Univ Sci B 2014; 15 (06) 522-532
    CrossrefPubMedGoogle Scholar
  • 20 Casselman FP, La Meir M, Jeanmart H. , et al. Endoscopic mitral and tricuspid valve surgery after previous cardiac surgery. Circulation 2007; 116 (11, Suppl): I270-I275
    CrossrefPubMedGoogle Scholar
  • 21 Maganti M, Badiwala M, Sheikh A. , et al. Predictors of low cardiac output syndrome after isolated mitral valve surgery. J Thorac Cardiovasc Surg 2010; 140 (04) 790-796
    CrossrefPubMedGoogle Scholar
  • 22 Obadia J-F, Messika-Zeitoun D, Leurent G. , et al; MITRA-FR Investigators. Percutaneous repair or medical treatment for secondary mitral regurgitation. N Engl J Med 2018; 379 (24) 2297-2306
    CrossrefPubMedGoogle Scholar
  • 23 Santana O, Funk M, Zamora C, Escolar E, Lamas GA, Lamelas J. Staged percutaneous coronary intervention and minimally invasive valve surgery: results of a hybrid approach to concomitant coronary and valvular disease. J Thorac Cardiovasc Surg 2012; 144 (03) 634-639
    CrossrefPubMedGoogle Scholar
  • 24 Nakamura T, Izutani H, Sekiya N, Nakazato T, Sawa Y. Beating heart mitral valve repair for a patient with previous coronary bypass: a case report and review of the literature. J Cardiothorac Surg 2013; 8 (01) 187
    CrossrefPubMedGoogle Scholar
  • 25 Rossi A, Dini FL, Faggiano P. , et al. Independent prognostic value of functional mitral regurgitation in patients with heart failure. A quantitative analysis of 1256 patients with ischaemic and non-ischaemic dilated cardiomyopathy. Heart 2011; 97 (20) 1675-1680
    CrossrefPubMedGoogle Scholar
  • 26 Stone GW, Lindenfeld J, Abraham WT. , et al; COAPT Investigators. Transcatheter mitral-valve repair in patients with heart failure. N Engl J Med 2018; 379 (24) 2307-2318
    Google Scholar
  • 27 Maisano F, Taramasso M, Nickenig G. , et al. Cardioband, a transcatheter surgical-like direct mitral valve annuloplasty system: early results of the feasibility trial. Eur Heart J 2016; 37 (10) 817-825
    Google Scholar
  • 28 Ad N, Holmes SD, Shuman DJ, Pritchard G, Massimiano PS. Minimally invasive mitral valve surgery without aortic cross-clamping and with femoral cannulation is not associated with increased risk of stroke compared with traditional mitral valve surgery: a propensity score-matched analysis. Eur J Cardiothorac Surg 2015; 48 (06) 868-872 , discussion 872
    CrossrefPubMedGoogle Scholar
  • 29 Wani ML, Ahangar AG, Singh S. , et al. Efficacy and safety of beating heart mitral valve replacement. Int Cardiovasc Res J 2014; 8 (02) 61-65
    PubMedGoogle Scholar
  • 30 Umakanthan R, Petracek MR, Leacche M. , et al. Minimally invasive right lateral thoracotomy without aortic cross-clamping: an attractive alternative to repeat sternotomy for reoperative mitral valve surgery. J Heart Valve Dis 2010; 19 (02) 236-243
    PubMedGoogle Scholar