RIGHT MINITHORACOTOMY APPROACH IN ATRIO-VENTRICULAR VALVE INFECTIVE ENDOCARDITIS: SINGLE CENTRE EXPERIENCE
Heart Hospital G.Pasquinucci FTGM, Massa, Italy.
OBJECTIVE: Right minithoracotomy (RT) is an alternative surgical approach for patients undergoing mitral valve (MV) or tricuspid valve (TV) surgery. However, the role of this technique in patients with infective endocarditis (IE) remains unclear. The objective of this study was to examine the feasibility and outcomes following minimally invasive atrio-ventricular valve (A-VV) surgery for IE.
METHODS: Between January 2004 and September 2012, 69 patients underwent A-VV surgery for IE. Of these fifty-eight (84%) patients had a RT. A retrospective review of this patient population was performed.
RESULTS: In-hospital mortality was 3% (n=2). Mean age was 59,6±13,6 years and mean Logistic Euroscore was 12,1±8,75. Forty-nine patients (84%) had native mitral valve IE and 9 (16%) had prosthetic mitral valve IE. Thirty-five patients (60%) were operated during the active phase of IE. Cardio pulmonary bypass time, cross clamp time and operation time was respectively 143±92,2; 96,7±29 and 264,2±71,3 minutes. Twenty-four patients (41%) received a mitral prosthesis and 34 (70% of pts with native MV IE) received a mitral repair. In 3 (5%) cases a residual moderate mitral insufficiency (MI) was accepted. In 3 (5%) patients deterioration of neurocognitive function was found. One patients had conversion to full sternotomy due to pleural adhesions. Freedom from IE as well as reoperation was 100%.
CONCLUSIONS: Minimally invasive A-VV surgery is a safe and feasible option for active IE and valve repair can be achieved in a high percentage of patients. However, IE still remains a high risk predictor for mortality and morbidity.
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