Minimally Invasive Mitral Valve Surgery Our Experience
Azamat Kurmalayev, Ermagambet Kuatbayev, Darkhan Suigenbayev, Shaimurat Tulegenov, Gaukhar Amreeva, Zhanibek Ashirov, Muradim Murzagalyev, Yuriy Pya.
National research center for cardiac surgery, Astana, Kazakhstan.
Objective: The objective of this prospective cohort observational study was to assess outcome of mortality, bleeding and on clinical outcomes staying in hospital, bypass time and pain.
Methods: Starting from January 2013 and December 2016 JSC "National Resarch Cardiac Surgery Center" in Astana performed 229 operations through minimally invasive access using thoracoscopic video equipment. 115 (50,21%) patients had mitral valve surgery. Mitral valve pathophysiology was regurgitation in 66 (57%), stenotic 41 (36%) and mixed 8 patients (7%). Mitral valve disease had: 51 (44,4%) rheumatic, myxomatous 54 (47%) (23 (42,6%) anterior leaflet prolapse, 30 (55,5%) posterior leaflet prolapse, 1 (1,9%) bileaflet prolapse), 7 (6%) dilatative cardiomyopathy, 2 (1,7%) endocarditis, 1 (0,9%) congenital . 64 (56%) patients primarily underwent Mitral valve repair (14 (22%) Annuloplasty, 31 (48%) Chordoplasty, 16 (25%) Posterior leaflet resection and sliding valvuloplasty, 2 (3%) augmentation, 1 (2%) Cleft closure) and 51(44%) underwent Mitral vale replacement (26 (51%) biological and 25 (49%) mechanical valve). In 4 cases, of mitral valve surgery monopolar radiofrequency ablation of the left atrium.
There was no hospital mortality. Rethoracotomy for bleeding from intercostal arteries was made in one case. Conversion to sternotomy was made in 2 patients because of adhesive pericardium. After surgery hospital stay was 4-5 days. The average time of cardiopulmonary bypass and aortic clamping was 125,4±15 min./65,8±5 minutes respectively.
Our experience with mitral valve repair and replacement through right minithoracotomy demonstrates that minimally invasive mitral valve surgery is a feasible method that can be performed safely and effectively. It is associated with very low rates of conversion. The failure rate of repairs is extremely low, especially in the hands of experienced surgeons.
Thus, about half of our cases are complicated and most of them have rheumathological heart diseases. This type of complexity makes valve harder to repair and in some cases the only solution for them is replacement.
Implantation of biological prosthesis through minimal invasive surgery with right thoracotomy should ease conducting medium sternotomy afterwards, thus making a second intervention more bearable and with less complications
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