Minimally Invasive Mitral Valve Replacement In Rheumatic Disease With Continuous Suture Technique
Pham Q. Dat, MD1, Duong Duc Hung, MD1, Duong Thi Hoan, MD1, Vuong Hai Ha1, Nguyen Huu Uoc, MD2.
1Vietnam National Heart Institute, Hanoi, Viet Nam, 2Hanoi Medical University, Hanoi, Viet Nam.
BACKGROUND: Minimally invasive mitral valve surgery has become a routine procedure in many institutions. The disadvantage of this approach is prolonged aortic cross-clamp and cardiopulmonary bypass (CPB) times. Replacement mitral valve with continuous suture technique helps reduce cross-clamp time and CPB time. We report our preliminary experience with patients undergoing minimally invasive isolated mechanical mitral valve replacement in rheumatic disease with continuous suture technique. METHODS: Between January 2018 until October 2018, a total of 15 patients with mitral valve rheumatic disease underwent replacement mechanical valve with continuous suture technique through a right small thoracotomy with peripheral cannulation at Vietnam National Heart Institute. We analyzed the 30-day mortality and postoperative complications of this group. RESULTS: The mean age was 50.4 ± 7.6 years consisted of 5 (33.3%) males, mean LVEF was 64.7±5.2 %, mean NYHA was 2.5 ± 0.49. There were 8 (53.3%) patients were performed concomitantly left appendage exclusion. Intermittent antegrade warm blood cardioplegia was used as myocardial protection in all patients, mean CPB time 87.9 ± 20.1 min, cross-clamp time 53.7 ± 13.9 min, mean mechanical ventilation time was 12.9 ± 8.9 hours. Mean ICU time was 47.5 ± 16.62 hours, Length of stay was 11.7 ± 3.9 days. Complications: No conversion to median sternotomy needed; No cerebrovascular accidents; Groin seroma: 1 (6.7%) patient; Pneumothorax: 2 (13.3%) patients; Overall 30-day mortality was 0%. Pre-discharge echocardiography revealed no residual. CONCLUSIONS: Our preliminary result was acceptable and demonstrate that minimally invasive mitral replacement with continuous suture technique can be performed safely and effectively and help reduce the cross-clamp time and CPB time, however long-term follow-up as well as large numbered, multi-centered research are needed for further assessment.
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