Totally Endoscopic Mitral Valve Repair: New Technique For Mitral Valve Exposure
Dat T. Pham1, Ngoc Thanh Le1, Quoc Hung Doan2, Cong Huu Nguyen1.
1E Hospital, Hanoi, Viet Nam, 2Hanoi Medical University Hospital, Hanoi, Viet Nam.
Background: Good exposure of the mitral valve (MV) is the key factors for a successful mitral valve repair. Many instruments were developed for minimally invasive mitral valve surgery (MIMVS) but it has sometimes failed to provide sufficient exposure of the MV. We report a new MV's exposure approach.Methods:MIMVS using peripheral bypass, 3-4cm right thoracotomy and several thoracoport become our standard procedure. MV is exposed by opening the left atrium (LA). We only use sutures to expose MV. Five Prolene 4/0 suturesare used. The first and second sutures are to hang LA at the edge of atriotomy (interatrial groove side). The third suture is to pull LA at opposite edgeof atriotomyto the pericardium. The fourth and fifth are to hang the roof of LA on or through the thorax, normally at 10 o'clock and 2 o'clock, 1-2 cmawayfrom anterior mitral annulus. An additionalsuturecan be usedfor posterior wall of LA, was attached to the right diaphragm. Conventional LA retractor with supporting arm and rib retractor were not necessary.Results:From November 2016 to April 2019, 56 patients were operated on successfully without extending chest incision or conversion to median sternotomy. The mean age was 55.8 ± 15.6 years. Cardiopulmonary bypass and aortic clamp times were 172 ± 30 and 115 ± 32 minutes, respectively. Repair techniques included annuloplasty 96%, leaflet resection 36%, leaflet plication 45%, artificial neo-chordae 19%, anterior leaflet augmentation 3.6%. Overall, in-hospital and 30-day mortality were 1.8 %. Major morbidities included 1 stroke, 2 bleeding and 1 pericardial effusion requiring intervention. Post-op echocardiography shows the degree of mitral regurgitation: none or trace (36), mild (18) moderate (n=2), severe (0).Conclusions:Ourhand-made hanging suturesis: safe, not bulky, easy to perform with excellent effectivenessandlower operating cost.
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