High Mitral Repair Rate Through Minithoracotomy Always Possible?
marco diena, MD.
Cardioteam Foundation. San Gaudenzio Clinic, Novara, Italy.
OBJECTIVE: Mitral valve repair is the operation of choice in degenerative disease. When the anterior leaflet is involved it is considered a challenge for surgeons, namely via a mini access. Here we analize our results to assess if a complex anatomy allows a high repair rate.
METHODS: From january 2009 to September 2016 we operated on 312 patients for severe mitral regurgitation due to a degenerative disease.38% of them had a bileaflet or anterior prolapse or flail and 62 % isolated posterior prolapse. We used a simplified minimally invasive technique (SMIT) with direct aortic cannulation, single venous drainage even in combined tricuspid repair. A intraoperative TEE echo analysis of each scallop was performed.In alla cases we implanted a prosthetic complete ring.
RESULTS: Mortality rate was 0.3%. repair rate was similar in posterior leaflet prolapse 100% and in bileaflet and anterior prolapse 100%. We had 1% of conversion to sternotomy in the first 12 cases.In 3% of cases we had to go back on pump to reduce a residual regurgitation. In all patients we obtained a good length of coaptation, at least 7 mm.
CONCLUSIONS: In our experience a very high repair rate is achieveble through minithoracootmy in single and bileaflet prolapse or flail with a simplified technique. A proper intraoperative TEE analysis of each scallop is mandatory togheter with a previous experience of complex repair via sternotomy.
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