Mitral Valve Surgery On The Fibrillating Heart
Daniel Hoefer, Herbert Hangler, Christoph Krapf, Nikos Bonaros, Johannes Holfeld, Cenk Özpeker, Michael Grimm, Ludwig Mueller.
Cardiac Surgery Innsbruck, Innsbruck, Austria.
Background: To evaluate feasibility, safety and outcomes of mitral valve surgery via lateral mini-thoracotomy without aortic cross clamping.Methods: Between 2010 and 2018 a total number of 563 minimal invasive mitral valve procedures were performed. In 22 cases (3.9%) the operation was accomplished without aortic cross clamp on the fibrillating heart. Either 2D or 3D video assistance after lateral mini-thoracotomy was used in all cases.Results: Mean age was 63.5 years, 14 (64%) were male, 8 (36%) female. All patients had underwent at least one prior cardiac surgery, covering a broad spectrum of different procedures. Cannulation for extracorporeal circulation was performed via femoral vessels in 14 (64%) patients, in 8 (36%) the axillary artery was used due to severe aortic sclerosis. After preparing the left atrium ventricular fibrillation was induced and maintained throughout the procedure. Mean bypass time was 210 minutes, mean fibrillation time was 123 minutes. In 12 patients (55%) successful mitral valve repair was accomplished, in 10 (45%) the mitral valve was replaced. Concomitant tricuspid valve repair was performed in 4 (18%) patients, in 2 (9%) patients additional atrial ablation was done. Major complications occurred in few patients (1 ECMO due to lung edema, 2 revisions due to bleeding), 21 patients (95.5%) were discharged home, 1 (4.5%) patient died from intracerebral bleeding. No further mitral valve intervention was necessary in all survivors.Conclusions: Mitral valve surgery without aortic cross clamp via lateral thoracotomy is feasible with acceptable repair rates. Perioperative morbidity is low, procedural survival is excellent. This type of surgery is an attractive alternative in redo patients in a specialized center.
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