Early Outcome Of Mitral Valve And Aortic Valve Replacement Via Minithoracotomy
Anh T. Vo, Dinh Nguyen, Huy Ngo, Trang Nguyen, Chuong Pham, Thien Vu, Anh Tuan Tho Pham
Ho Chi Minh City University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
Background: Minimally invasive surgery has become a strongly developing trend in cardiac surgery. The success of mitral valve interention via a minithoracotomy has created a motivation in pushing this trend to a further limit: Double valve replacement. We report our premilinary experience with patients undergoing minimally mitral valve and aortic valve replacement.
Methods: Between January 2016 and November 2017, 21 patients with mitral valve dysfunction and aortic valve disease underwent minimally invasive surgery through a right minithoracotomy approach at the University Medical Center of Ho Chi Minh City,Vietnam. We analyzed the 30-day mortality and postoperative complications of this group.
Results: The mean age was 45.3. Fifteen patients (71.4 %) were male. The predominant pathology was chronic rheumatic valve disease (80.9%), followed by degenerative disease (9.5%) and 1 endocarditis (4.7%). Mechanical valve replacement was performed in 17 patients, the other 3 patients were implanted with bioprosthesis. Custodiol solution was used as myocardial protection in all patients, average cardioplegic time was 1.7. Mean cross clamp time was 172.6 minutes, cross clamp time was decreasing gradually patient after patient. Mean cardiopulmonary bypass time was 237.2 minutes. Mean mechanical ventilation time was 32.3 hours. Mean ICU time was 2.4 days. Thirty-day mortality was 4.7%. No conversion to median sternotomy needed. 2 bleeding required reoperation for hemostasis via the thoracotomy. 2 (9.5%) patients developed transient renal failure due to prolonged CPB time but no dialysis was required. 1 patient had cerebral hemorrhage at postoperative day 1 and died 2 days after. Paravalvular leaks in the aortic valve were discovered in 2 patients but the quantity of the leak is less than moderate and medical treatment and follow-up was chosen.
Conclusions: Our preliminary result was acceptable and demonstrate that minimally invasive mitral and aortic valve replacement can be performed safely and effectively with few perioperative complications, however long term follow-up as well as large numbered, multi-centered research are needed for further assessment.
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