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SHORT TERM OUTCOMES AFTER MINIMALLY INVASIVE REPAIR OF BOTH ATRIOVENTRICULAR VALVES IN 51 PATIENTS
Marc Albert, Ragi Nagib, Hardy Baumbach, Ulrich F.W. Franke.
Robert-Bosch-Hospital, Stuttgart, Germany.

OBJECTIVE: The minimally invasive access via right-sided mini-thoracotomy has become the standard technique for the repair of the atrioventricular valves. However, many patients suffer from regurgitation of both atrioventricular valves, and because of the concomitant right heart failure with subsequent secondary organ dysfunctions the perioperative risk may be higher when reconstructing both valves simultaneously. In this study we demonstrate the short-term outcome after combined repair of both valves.
METHODS: Between November 2008 and August 2015 46 patients underwent minimally invasive simultaneously reconstruction of both atrioventricular valves. Patients with endocarditis, redo procedures or conversion to median sternotomy were excluded. Patient demographics and intraoperative data are shown in table 1.
RESULTS: Seven patients (15.2%) died in the perioperative course. There was no perioperative infarction requiring intervention, two post-operative strokes (4.3%). A total of 6 patients (13.0%) required a pacemaker-implantation because of AV-block, 4 patients after ablation of atrial fibrillation. The length of hospital stay was 15.4 ± 9.1 days and length of ICU stay was 3.4 ± 3.5 days.
CONCLUSIONS: Not surprisingly, in the early post-operative course the simultaneously reconstruction of both atrioventricular valves has a higher risk regarding major complications and a longer length of stay on ICU an in hospital compared to an isolated mitral valve repair reported in the literature. To limit the ischemia of the heart more that 40% of all tricuspid repairs were done during the reperfusion period using the beating heart technique. Further investigation about the long term results should follow.
Table 1
Euroscore8.7 ± 3.8
BMI [kg/m²]25.2 ± 4.0
LVEF [%]55.4 ± 13.6
Severity of mitral regurgitation [grade]3.0 ± 0.5
Severity of tricuspid regurgitation [grade]2.8 ± 0.7
Operation time [min]240 ± 42
Cross-clamp time [min]97 ± 25
Closure of left atrial appendage [n]12 (26.1%)
Ablation of atrial fibrillation [n]28 (60.9%)
Tricuspid repair beating heart [n]19 (41.3%)


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