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Minimally Invasive Mitral and Aortic Valve Surgery Through Right Anterior Minithoracotomy:
First results.

Antonio Miceli, Michele Murzi, Danyiar Gilmanov, Raffaele FugÓ, Stefano Bevilacqua, Matteo Ferrarini, Simone Simeoni, Alfredo G. Cerillo, Pier A. Farneti, Marco Solinas, Mattia Glauber.
Fondazione Toscana G. Monasterio, Massa, Italy.

OBJECTIVE: Minimally invasive surgery for either mitral or aortic valve surgery through right anterior minithoracotomy (RT) has shown excellent results in terms of mortality, morbidity and patients satisfaction. However, no study has described the combined minimally invasive mitral and aortic surgery (MIMAS) through RT. Aim of our study was to report early outcomes in patients undergoing MIMAS through RT.
METHODS: From October 2005 to December 2012, 18 patients underwent MIMAS through RT. Additional procedures were: tricuspid valve repair (n=5) patients, atrial fibrillation surgery (n=5) and miectomy (n=1). A 7-8 cm skin incision was perfoemd through the 3rd intercostal space Cardiopulmonary bypass was achieved by direct ascending aortic cannulation and percutaneous femoral vein drainage into right atrium.
RESULTS: No death occurred. Mean age was 66▒12, 12 patients (70%) were female and the median EuroSCORE was 7 (interquartile [IQ] range 3-12). The mean cardiopulmonary bypass and cross clamp time were 166▒41 min and 126▒29 min respectively. No patient required a conversion to standard sternotomy. The median ventilation time was 7 hours (IQ range 5-16), as well as the median for intensive care unit and hospital stay was 1 day (IQ range 1-1) and 6 (IQ range 5-9). One patient had a postoperative stroke, another patient required blood transfusion and incidence of postoperative atrial fibrillation was 22% (n=4).
CONCLUSIONS: Minimally invasive mitral and aortic surgery through RT is a safe procedure associated with excellent early outcomes. More studies are required to validate our data.

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