Minimally Invasive Direct-vision Right Minithoracotomy Technique For Mitral Valve Repair
ALIAKSANDR ZHYHALKOVICH, Sr.1, Aliaksandr Ziankou2, Dzmitry Turluk1, Pavel Ladygin1, Marat Ilyasou1, Yuriy Ostrovsky1.
1National Center of Cardiology, Minsk, Belarus, 2Vitebsk regional clinical hospital, Vitebsk, Belarus.
OBJECTIVE: Minimally Invasive right minithoracotomy technique for mitral valve pathology has become an alternative to the median sternotomy approach. We report a single-center experience with direct-vision minithoracotomy technique for mitral valve repair (DVMTMVR).
METHODS: : From September 2013 to September 2016 we performed 55 operations using DVMTMVR. It concerned 25 males and 30 females with the average age 45,4 +-11,6 years (range 21-68 years). All patients had prevalent mitral insufficiency (ERO 0,4±0,12 см2, RV 52±14ml) due to the primary prolapse of posterior leaflet in 36, anterior leaflet prolapse in 6 and bileaflet prolapse in 13 cases. 8 (14,8%) patients were in NYHA III. We used a right minithoracotomy in fourth intercostal space 5 to 7 cm in length, CPB was implemented with femoral artery and vein, right internal jugular vein (8 cases) cannulations. Mitral ring was implanted in all patients, e-PTFE neo-chordae implantation - 6 (11%), resection of the leaflet - 25 (45%), edge-to-edge repair - 5 (9%), sliding plasty - 5 (9%), plication of the leaflet - 16 (29%).Concomitant procedures were MAZE procedure (n=2), interatrial defect closure (n=3).
RESULTS: : Mean CPB time and x-clamp time were 125±20,76 and 84,5±14,8 min respectively. There were no in-hospital mortality, no major neurological events and no conversions to sternotomy. We had one rethoracotomy for bleeding and transient ischemia of the right foot in two cases. We achieved good results of mitral valve repair in operating room in all cases. In follow-up (mean 16 months) we observed no or trivial MR in 46 (84%) pts, and mild MR (1+) in 9 (16%) pts. There were no late deaths.
CONCLUSIONS: Minimally invasive direct-vision right minithoracotomy is a safe and reproducible technique for mitral valve repair with low rates of peri-procedural complications and good mid-term results.
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