Minimally Invasive Video Assisted Concomitant Multiple Valve Surgery Through Right Anterior Mini-thoracotomy
Serkan Durdu, cagdas baran, Fatih Gumus, mehmet cakici, evren ozcinar, ali ihsan hasde, mustafa sirlak, ahmet ruchan akar.
Ankara University, ankara, Turkey.
Objective: The minimally invasive approach to cardiac surgery has gained increasing acceptance and popularity in past decade but it is mostly involved in single valve replacement for aortic or mitral valve disease. Our aim with this study to show that our experience and method performed in 15 patients is safe and effective for double (mitral and aortic) or triple (mitral, aortic and tricuspid) valve implantation concomitantly through right anterior mini-thoracotomy.Methods: We performed multiple valve replacement concomitantly in 280 patients between January 2013 and August 2017, 15 of them underwent multiple valve implantation (double valve replacement for 12 patients, triple valve implantation for 3 patients) through right anterior thoracotomy. All patients underwent preoperative screening of the aorta with computed tomography for evaluating the position of aort itself. Peripheral bicaval cannulation were preferred for cardiopulmonary bypass via right femoral artery, vein and superior vena cava. Minimally invasive approach through right anterior thoracotomy from third intercostal space was performed for all patients. One-year clinical and echocardiographic follow-up was obtained in all survivors.Results: The mean age was 72.1 ± 1.95 years ranging from 68 to 76 and 53.3% (n=8) were male. All implanted valves were in biological pattern. Mean preoperative EF% was 54.2 ± 3.9. There was only one in-hospital mortality due to severe septic shock and low cardiac output. Mean follow-up was 13.8 ± 3.2 months. Average length-of-stay was 6.4 ± 1.2 days. No major paravalvular leakage occurred, and no postoperative valve migration.Conclusion: This study shows that multiple valve implantation concomitantly through RAT is a technically feasible and safe procedure in selected patients with acceptable good surgical outcomes. 
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