Minithoracotomy approach for repair of mitral, tricuspid valves, atrial septal defects and atrial tumors removal in octogenarians.
Jakub Piotr Staromłyński, Radosław Smoczyński, Anna Witkowska, Paweł Stachurski, Wojciech Sarnowski, Jarosław Świstowski, Dominik Drobiński, Piotr Suwalski.
Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland.
OBJECTIVE: Minimally invasive cardiac surgery is becoming more and more popular. Due to decreased tissue traumatization it provides better haemostasis. Small incision and untouched shoulder girdle enable fast recovery. The minimally invasive procedure maybe an excellent choice for high risk patients. Twenty patients aged 80 years and older of 235 all-comers were analyzed. All octogenarians were operated through right minithoracotomy.
METHODS: Between November 2011 and December 2015, 20 consecutive patients aged 80 years and older of 235 all-comer were operated through right minithoracotomy. We performed mitral valve and tricuspid valve repair or replacement. In two cases atrial myxomas were removed. The surgical access was made through right lateral minithoracotomy with use of extracorporeal circulation via femoral vessels. In one case cannulation via cervical vessels was provided. When tricuspid valve was involved additionally right internal jugular vein was cannulated.
RESULTS: Preoperative comorbidities included insulin-dependent diabetes mellitus in 31.25%, COPD in 32.25%, The mean left ventricular ejection fraction was 57±13.1 %. Mean EuroScore II was 3,32±3,53 %. Postoperatively, 1 patient required rethoracotomy due to bleeding (5%). During first 24 hours we observed mean drainage - 371,25±208,2 ml. Blood transfusion rate was low: 1,8±2,7 unit. Time of total ventilation/intubation was 16.21 hours, which was driven by tricuspid patients. Early appropriate rehabilitation had been implemented during the first day in postoperative period. No mortality was observed in 30 days. We did not observe conversion to full sternotomy, vascular complication and wound infection.
CONCLUSIONS: Our consecutive all-comers patients showed that right minithoracotomy is a safe and feasible approach in octogenarians, referred to mitral and tricuspid surgery.
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