Totally Thoracoscopic Mitral Valve repair with modify Loop technique
Cardiovascular Department of GuangDong Province People’s Hospital GuangZhou China, GuangZhou, China.
OBJECTIVE: summarize the experience of Totally Thoracoscopic Mitral Valve repair with modify Loop technique
METHODS: From July 2011 --July 2015 only one surgeon performed 65 cases of totally thoracoscopic Mitral Valve repair with modify Loop technique. whole group has 38 Males, 27 Females . Age 19-79(48.9±24.3). Weight 43~90(51±15)kg . Combined procedure: TVP Ring 16. 21 cases were Anterior leaflet prolapse, 27 cases were Posterior leaflet prolapse 17 cases were bileaflet prolapse .All patient under went Right anterior minithoracotomy with three holes .Double lumen trachea cannula . Use femoral artery , vein and vena jugularis externa cannula to set up CPB . Gore-Tex loop stitch point:one side is on the junction between papillary muscle and chordae ,another side is one the edge of the prolapse leaflet .Number of chordaes 3.5±1.3 . Length of artificial chordae: Anterior leaflet :1.65~1.88(1.7±0.8)cm,Posterior leaflet: 1.5~1.7(1.6±0.1)cm. All cases used Edwards physio I or II ring. For bileaflet prolapse cases we used modify Loop technique that we used hand make different length artificial chorda in one group of loop.
RESULTS: no mortality,2 cases Convert to MVR. CPB time: 123.24± 38.22min, Crossclamp time: 79.83±29.48min, Ventilation time: 14.2±8.8h, drainage(/ml ) 327.5±311.5, ICU stay(/h)24.3±14.2, Hospital stay(/d ) 6.4±3.9, reoperation for bleeding 2 cases, pulmonary infection 6 cases, Wounded infection 1 case. Mitral
insufficiency(MI)(pre op) 12.6±5.09 cm2, MI(discharge) 0.83± 1.29 cm2 , P<0.001, MI(3 months) 1.58±2.01 cm2. Involution height: 0.5~1.5(0.85±0.43)cm
CONCLUSIONS: Mitral valve repair with totally endoscopic is feasibility, safety, reproducibility and have good clinical result. Modify Gore-Tex loop technique can simplify the request of implanting artificial chordae specially for Bileaflet prolapse
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