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Clinical Outcomes of Patients More Than One Year after Minimally Invasive Mitral Valve Repair and Replacement Surgery with Sutures Secured using Automated Titanium Fasteners
Roberto Rodriguez, MD, Francis P. Sutter, DO, Louis E. Samuels, MD, Daniel Ice, MD, Susan Morrissey, Kathleen M. Holzerman, RN, Scott Goldman, MD.
Lankenau Medical Center, Wynnewood, PA, USA.

OBJECTIVE: To evaluate the clinical outcomes of minimally invasive cardiac surgery patients followed for at least one year after mitral valve repairs and replacements with prosthetic attachment sutures secured by automated titanium fasteners.
METHODS: We conducted a single-institution retrospective review of clinical outcomes for patients involved in an on-going IRB study regarding minimally invasive mitral valve surgery. During the 26-month period from November 2008 to December 2010, a total of 133 minimally invasive mitral valve repairs or replacements were performed at our institution using automated titanium fastener technology. Patient post-operative histories, physician records and follow-up studies, such as echocardiography, were analyzed.
RESULTS: Patient records from a total of 119 consecutive mitral valve repairs and 14 mitral valve replacements were reviewed. All mitral prosthetic rings were successfully attached with automated titanium fasteners. All 14 mitral valve replacements were also secured without manually tied knots. Other concomitant procedures included 48 MAZE procedures and 22 patent foramen ovale closures. A total of six study procedures were reoperations, with the previous procedure being coronary artery bypass surgery.
Whenever possible, patient mitral valves were evaluated by echocardiography post-operatively and/or by the surgeon at the one-year follow-up visit. Twenty-three patients (17%) were lost to follow-up. The latest echocardiogram was performed an average of 505 days following surgery. No patient had evidence of thrombus formation or hemolysis. One instance of mitral ring dehiscence was noted amongst the repair patients and no perivalvular leaks occurred amongst the replacements. In the patient with the mitral ring dehiscence, the dehiscence was due to a tear in the mitral annulus and not associated with the titanium fasteners, which all remained intact. The overall study mortality rate was 1.5% and stroke rate was 2.25%. No adverse outcomes were attributable to the use of automated titanium fasteners.
CONCLUSIONS: At a minimum of one-year follow-up, automated titanium fasteners appear to be safe and effective for securing prosthetic attachment suture in minimally invasive mitral valve repair and replacement surgery.


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