The Results Of Minimally Invasive Mitral Valve Replacement
Rustem Tuleutayev, Sr., Bauyrzhan Rakishev, Sr., Ualikhan Immamirzayev, Sr., Timur Ibragimov, Sr., Alibek Oshakbayev, Sr., Zhenis Koshkinbayev, Sr., Daurenbek Urazbekov, Sr., Askhat Kudaibergen, Sr..
NATIONAL SCIENTIFIC CENTER OF SURGERY named after A.N. SYZGANOVA, Almaty, Kazakhstan.
BACKGROUND. Assess the early results of the technique of minimally invasive mitral valve replacement. Chronic rheumatic heart disease is one of the most common causes of morbidity and mortality among the population. Isolated mitral valve disease is diagnosed in 55-60% of patients. Acquired heart defects in frequency occupy the third place after hypertensive and coronary disease.
Modern techniques of minimally invasive mitral valve replacement can reduce the risk of postoperative complications and shorten the period of hospitalization. One of these techniques is a mini-invasive mitral valve replacement from a mini-access (minimally invasive correrection - MIC). METHODS. For the period from February 2015 to January 2018 in the Scientific Center of Surgery named after A.N. Syzganov performed 22 operations of mini-invasive mitral valve replacement from a mini-access. One of the main indications for surgery was an isolated hemodynamically significant lesion of the mitral valve. The operation was performed through a right-sided anterolateral mini-thoracotomy in the fourth intercostal space. The main stage of the operation was performed using the heart-lung machine with video-assisted thoracoscopic support. RESULTS. Among 22 patients there were 5 male, 17 female. There was no need for a transition to mid-sternotomy. The average time of cardiopulmonary bypass (IC) was 140 ± 17 minutes, aortic occlusion (Ao) ± 70 minutes. The median intervention time was 250 ± 17 minutes. The length of the skin incision ranged from 5-7 cm.
The time spent in the intensive care unit was 1 day, after which the patients were transferred to the general ward of the cardiac surgery department. Infectious complications of the skin and subcutaneous tissue are not marked. No deaths were recorded. All patients in the postoperative period are marked by regression of the clinic.CONCLUSIONS. The technique of minimally invasive mitral valve replacement is becoming more widely used in cardiac surgery. When performing an operation through the right-sided anterolateral mini-thoracotomy in the IV intercostal space, the integrity of the chest can be maintained, and there is a low incidence of postoperative complications such as: bleeding, neurological disorders and wound infections. This method significantly reduces the time spent in the intensive care unit and the duration of the hospital period. The low invasiveness and high efficiency of the described technique make it possible to consider it as an alternative to traditional mitral valve replacement.
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