International Society For Minimally Invasive Cardiothoracic Surgery

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Up To 100% Mitral Valve Repair Through Minithoracotomy With A Simplified Technique
marco diena, gabriele Musica, Gheorghe Cerin, Mario Bobbio, Diana Botezatu, Gheorghe Cerin.
Cardioteam Foundation. San Gaudenzio Clinic, Novara, Italy.

Background. Despite clear data proving that mitral valve repair is the operation of choice in degenerative disease, the repair rate is still suboptimal for three major reasons: the difficulties to work through a small incision, the challenging bileaflet prolapse and the need of a perfect Echo assessment of each scallop. The purpose of this study was to evaluate if a simplified technique may allows an high repair rate through a small thoracotomy.Methods. From January 2011 to January 2018, 327 patients with a mitral prolapse underwent a mitral valve surgery via a right small thoracotomy in the third intercostal space. A simplified technique means a single endotracheal intubation, a single percutaneous venous cannula at the groin, a direct aortic cannulation with Custodiol cardioplegia and direct flexible aortic cross clamping. An intraoperative transesophageal echo was performed in all cases.A standard valve repair was accomplished. Results. Hospital mortality was 0.6 %. We could repair 100% of those valves, in three case we had to convert to sternotomy (1%) and in 3% of the cases a second pump run was necessary to adjust the repair.No patient was discharged with a mitral regurgitation more than mild. In all cases we had a good myocardial protection.Conclusions. Mitral valve repair is feasible through a small thoracotomy with a repair rate up to 100% with low risk and low compliction rate with this simplified technique that allows a very good surgical exposure, mandatory for complex repair togheter with a precise echo assessment. Minithoracotomy remain a demanding approach that need a proper training and tutoring.

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