International Society For Minimally Invasive Cardiothoracic Surgery

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Aortic Valve Closure Method For Checking The Repaired Mitral Valve Competence During Minimally Invasive Double Valve Surgery
Toshinori Totsugawa1, Arudo Hiraoka1, Kentaro Tamura1, Hidenori Yoshitaka1, Taichi Sakaguchi2.
1The Sakakibara Heart Institute of Okayama, Okayama, Japan, 2Hyogo College of Medicine, Nishinomiya, Japan.

OBJECTIVE: As the number of reports of minimally invasive concomitant mitral and aortic valve surgery is increasing, a simple and reliable method to assess the repaired mitral valve competency in an aortotomy setting is required even through a right mini-thoracotomy. Here we describe aortic valve closure method as a simple saline injection test during minimally invasive double valve surgery.
METHODS: Surgery was performed via a 7-cm 3rd intercostal anterolateral thoracotomy. Cardiopulmonary bypass was established with a femoral arterial cannulation with venous drainage from the femoral vein and the superior vena cava. In case of aortic insufficiency, crystalloid cardioplegic solution was directly administered into the coronary ostia following an aortotomy. First, the diseased aortic valve was suture closed using a 4-0 polypropylene running suture. Then the mital valve was approached through a right-sided left atriotomy and was repaired with usual techniques. To assess a competency of the mitral valve, saline was injected via the valve using a syringe. After completion of the valve repair, the sutured aortic valve was resected and was replaced with a prosthetic valve.
RESULTS: From February 2016, a competence of the repaired mitral valve in an aototomy setting was checked by this method and 4 patients underwent minimally invasive combined mitral valvuloplasty and aortic valve replacement via a right mini-thoracootmy. Mean age was 6511 years old. Aortic valve pathology was aortic insufficiency in all patients; mitral valve repair was performed in 3 patients and annuloplasty in 1 patient. Regarding additional surgery, pulmonary vein isolation was performed in 2 patients and tricuspid annuloplasty in 1 patient. Mean times of operation, cardiopulmonary bypass, cross-clamping were 38861, 28454, 18527 min, respectively. Mean follow-up period was 276 months and the degree of mitral regurgitation was trivial in 3 patients and mild in 1 patient.
CONCLUSIONS: Aortic valve closure method is a simple and reliable method to check the mitral valve competence in an aortotomy setting and is useful for minimally invasive double valve surgery through a right mini-thoracotomy.

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