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International Society For Minimally Invasive Cardiothoracic Surgery

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Minimally Invasive Treatment Of Multiple Valve Disease: 3-year Experience
Antonio Lio, Federico Ranocchi, Andrea Montalto, Marcello Bergonzini, Antonio Giovanni Cammardella, Marco Russo, Guglielmo Saitto, Francesca Nicoḷ, Francesco Musumeci.
Department of Cardiac Surgery and Heart Transplantation, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy.

Background. Minimally invasive cardiac surgery has obtained an increasing consensus. However, there is little experience with minimally invasive treatment of multiple valve disease and no standard techniques have been provided yet. We describe our 3-year experience with concomitant mitro‐aortic or triple valve surgery through a right minithoracotomy (RmT), highlighting some technical aspects of our approach. Methods. From April 2017 to October 2019, 37 patients with multiple valve disease were operated by this method. A 3-4 cm skin incision is performed at the level of anterior axillary line entering into the 3rd intercostal space (ICS). Cardiopulmonary bypass (CPB) is estabilished with a femoro-femoral platform. Surgery on the mitral valve (MV) is performed first and sutures put into the mitral annulus. Aortic valve replacement (AVR) is performed next. Then, the selected ring or prosthetic valve is implanted in the mitral position throughout previously placed sutures. Finally, tricuspid valve surgery is accomplished. Results. There were 18 women (48%) with a mean age of 67 ± 8.5 years. Mean EuroScore II was 5.8 ± 5.9. In combined with AVR, MV replacement was performed in 23 patients (62%),and MV repair in 14 patients (38%). All cases of degenerative mitral regurgitation were addressed by MV repair. Concomitant tricuspid annuloplasty was performed in 8 patients (22%). Aortic cross-clamp and CPB times were 136 ± 18 and 183 ± 31 minutes, respectively. Postoperatively, only 1 patient (2.5%) died. No significant morbidity was recorded. Postoperative echocardiography showed no perivalvular leakage in aortic or mitral position. No residual mitral regurgitation was observed in patients who underwent MV repair. At a median follow‐up of 12 months, no late death occurred and no patient required reoperation. Conclusion. Minimally invasive surgery of double and triple valve disease is feasible. Our approach through a lateral RmT allows optimal visualization of the aortic, mitral, and tricuspid valves, and reduces the interference of prosthetic material, maintaining elasticity of the tissues, to simplify the whole surgical procedure. Moreover, our technique allows excellent results in complex MV repair procedures and, performing AVR before MV procedure ending, the aortic annulus gets the size of the valve that it deserves.


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