Mitral Valve Surgery For Patients With Severe Comorbidities: Minimally Invasive Video Assisted Or Conventional Valve Surgery
NGUYEN CONG HUU, Sr..
Cardiovascular centre - E hospital, Ha Noi, Viet Nam.
Objective: This report was done with the aim to determine the feasibility and safety of of minimally invasive video-assisted mitral valve surgery for patients with severe cardiac lesions and comorbidities. Methods: 6 patients diagnosed with severe mitral stenosis, left atrial thrombus, giant left atrial enlargement, severe tricuspid regurgitation, severe pulmonary arterial hypertension with comorbidities: obesity, breast tumors, cerebral vascular accidents underwent minimally invasive video-assisted mitral valve replacement and concomitant left atrial thrombectomy, left atrial appendage closure, left atrial reduction and tricuspid annuloplasty ring. Peripheral extracorporeal circulation was set up through femoral vessels and right internal jugular vein canulation. Small right lateral mini-thoracotomy with 6 cm length incision through the 4th intercostal space was used. Chitwood transthoracic aortic cross-clamp, myocardial protection with antegrade cardioplegia(Custodiol solution) through a needle placed in the aortic root. Results: All patients were successfully operated. The average aortic cross-clamp time is 150 minutes, cardiopulmonary bypass duration is 210 minutes. The mean time in ICU is 3 days, hospital stay is 2 weeks. There was not any complication. Conclusions: Minimally invasive video assisted mitral valve surrgery is feasible and safe. It is and not contraindicated in severe cases. Surgical experience, advancements in anaesthesia and intensive care, medications and other supportive devices help to overcome the disadvantage of prolonged operative time.
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