Minithoracotomy approach for repair of mitral, tricuspid valves, atrial septal defects and cardiac tumors removal in 250 consecutive patients. 5 year follow up.
Jakub P. Staromłyński, Anna Witkowska, Radoslaw Smoczynski, Pawel Stachurski, Dominik Drobinski, Piotr Suwalski.
Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland.
Minimally invasive cardiac surgery is becoming more and more popular. Due to proven advantages of minimally invasive procedures such as: decreased tissue traumatization, which provides better haemostasis and untouched shoulder girdle that enables fast recovery. We analyzed consecutive 250 all-comers who were operated via right minithoracotomy.
Between November 2011 and January 2016 we performed right minithoracotomy in 250 consecutive patients. The surgical access was made through right lateral minithoracotomy with use of extracorporeal circulation via femoral vessels and cervical vessels. When the tricuspid valve was involved additionally the right internal jugular vein was cannulated.
Mean (SD) age was 63.9±12,8 years; Preoperative comorbidities included DM in 12,7% , COPD in 5,5%, chronic renal failure in 10,6%, active endocarditis in 2,5%. The mean EF was 54.7±12.0 %. The mean EuroScore II was 6,9±7,0 %. Three different groups of patients were selected according to the most common "high risk" definitions: patients over 80 years old, patients with EF below 35% and patients with EuroScore above 6 points. Median CBP was 166.2± 71.7min and cross-clamp times were 87.0 ± 49.5 min. We didn't observe conversion to full median sternotomy. Reopening for bleeding was necessary in 9 (3,8%) patients. Acute kidney injury was reported in 6 patients (2,5%). 4 patients had neurological complications (1,7%). The average stay in ICU were 2.4± 1.6 days. During first 24 hours we observed mean drainage- 395.2± 332.0 ml. Blood transfusion rate was 1.7±2,8. 30 days mortality was 2.9 %. In Kaplan-Meier 5- year survival showed, that 73±7,8% patients after mitral valve repair and 60±4,5% patients after MVR are alive.
Minimally invasive procedures via minithoracotomy are safe and feasible method in consecutive all-comers. In group of minimally invasive mitral repair we observed better survivability than in group after mitral valve replecament.
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