Early Results Of Minimally Invasive Video-assisted Mitral Valve Surgery: What We Learned?
MARCO ANTONIO P. OLIVEIRA1, Gustavo I. Juds1, Joao Antonio V. Caparroz1, Rafael Lencioni1, Lays Moreschi1, Mohamad Ghandour1, Diego Faria2, John Freitas2, Sergio A. Oliveira1.
1BP São Paulo and Hospital Israelita Albert Einstein, Sao Paulo, Brazil, 2BP São Paulo, Sao Paulo, Brazil.
Early Results of Minimally Invasive Video-Assisted Mitral Valve Surgery: What we learned? Background Minimally invasive mitral valve surgery has evolved during recent years achieving safety and efficacy outcomes equivalent to median sternotomy, however no consistent information is available on the training to perform this surgery. Therefore, it is necessary to assess the surgical team performance when beginning to apply this new technique. Methods Where included the first 38 consecutive patients undergoing MIMVS, operated by two cardiovascular surgeons, between April 1st 2014 and December 31th 2017. Patients were divided into 4 different groups according to procedure time line: from case 1 to 10; 11 to 20; 21 to 30 and 31 to 38. We defined surgical complication as the occurrence of one or more of the following events: perioperative death; intraoperative conversion to median sternotomy; postoperative femoral/aorta artery dissection; stroke; in-hospital reoperation for any cause and surgical wound infection Results Mitral valve repair (n=22) and mitral valve replacement (n=16) were performed for different pathologic conditions: Fibroelastic degeneration (n=32), rheumatic disease (n=5) and chronic endocarditis (n=1). This series showed no early mortality. Surgical complications occurred in five patients shared in all groups, except in group IV. There was a gradual decrease in cardio-pulmonary bypass and cross-clamp times during the study. Log linear also showed a decrease trend in length in the Intensive Care Unit and in total hospitalization. There was difference between groups regarding cardiopulmonary bypass, ICU and post-op hospitalization times. Comparing only the initial (group 1) and the final (group 4), there was significant difference for these three variables. None perioperative myocardial infarction, major stroke, femoral artery dissection or deep venous thrombosis were found. Atrial fibrillation was seen in four patients, all of them medically treated, without differences between the groups. Conclusion Despite long cardio-pulmonary bypass and cross clamping times, MIMVS can be performed by expert surgeons in mitral valve with no prior experience with this technique, as long as they received appropriated training and proctoring. We showed a decrease in ICU and hospitalization length of stay with the learning curve, enabling a faster overall rehabilitation without earlier mortality.
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