Simultaneous Aortic And Mitral Valve Replacement Through A Minimally Invasive 3d Videoassisted Approach
HECTOR R. DIAZ-GARCIA, LILIANA SILVA-FLORES, CARLOS JIMENEZ-FERNANDEZ, LUIS HIGUERA-MEDINA, ITALO MASINI-AGUILERA, OSCAR LOMELI-SANCHEZ, ALEXANDRA GALVEZ-BLANCO, DANIEL HIGUERA-MEDINA, BENIGNO FERREIRA-PIŅA.
ICMI MINIMALLY INVASIVE CARDIOVASCULAR INSTITUTE, Zapopan, Mexico.
BACKGROUND Few centers combine a common access through a minithoracotomy for aortic and mitral valvular surgery. We present a patient operated simultaneously on the mitral and aortic valve through a minithoracotomy with 3D video assistance and peripheral cannulation guided by fluoroscopy. A 71-year-old male with a diagnosis of symptomatic severe mitral regurgitation and severe aortic insufficiency was referred to our center. The patient was under medical treatment for chronic pulmonary thromboembolism and received 10 years ago an inferior vena cava filter. Method The cannulation for cardiopulmonary bypass was performed peripherally via femoral access guided by fluoroscopy due to a history of inferior vena cava filter as well as visualization with TEE. A second venous cannula in the jugular vein was placed. The surgical approach was through an incision of 5 cm in the 3rd intercostal space on the right hemithorax. A port for video assistance with a 3D in the 2nd intercostal space. Excellent exposure was obtained for the aortic and mitral valve. The native aortic valve was first removed. Then the mitral valve was approached resecting the body of the anterior leaflet and replacing the valve with a biological prosthesis, preserving the whole subvalvular apparatus. Subsequently, a biological prosthesis was implanted. CPB time 206 minutes and aortic cross-clamp time 181 minutes. The total surgical bleeding was 150 cc. RESULTS Extubation was achieved in the surgical room. The patientīs stay in the Intensive Care Unit (UCI) was 36 hours, beginning to walk in the first 24 hours after ICU admission. No transfusions were required. The patient was finally discharged home at the fifth postoperative day. Normal daily activities were reached after two weeks of the surgical procedure. CONCLUSIONS Although there is little literature on this approach, we can say that minimally invasive mitro-aortic valve surgery through a right minithoracotomy can be simultaneously be performed with low postoperative morbidity and mortality. MICS continues to revolutionize the surgical area.
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