FOUR APPROACHES TO AVOID STERNOTOMY IN CONCOMITANT CORONARY ARTERY GRAFTING AND MITRAL VALVE SURGERY
Volodymyr Demianenko, Oleksandr Babliak, Dmytro Babliak.
Diagnostic and Treatment Center For Children And Adults Of The Dobrobut Medical Network, Kyiv, Ukraine.
BACKGROUND: Minimally invasive coronary surgery and minimally invasive mitral valve surgery have been successfully performed independently. Patients with combined diseases are traditionally operated via sternotomy. METHODS: The growing experience in minimally invasive techniques over the last years increases the surgical expertise and provides the additional armamentarium to avoid sternotomy in this complex group of patients.We present our series of 26 patients who underwent a concomitant mitral valve and coronary artery bypass surgery with 4 different approaches without performing sternotomy.The I approach is the single right 5-7 cm lateral thoracotomy for mitral valve repair/replacement (MVR) and RCA grafting. This approach was used in 6 patients. Mitral valve (MV) was operated using the conventional video-assisted minimally invasive technique and single coronary grafting was performed using the same thoracotomy.The II approach is bilateral minithoracotomies. It was used in 10 patients, Right lateral minithoracotomy was used for MVR, left anterior minithoracotomy - for CABG.Left anterior minithoracotomy as a single approach for CABG and MVR was used in 8 patients (the III and IV approaches). In 6 patients MVR was done during left ventricular (LV) aneurysm repair through the incision of LV wall (the III approach). In 4 patients MVR was done though the right atrium and interatrial septum incision (the IV approach).RESULTS:In total MV repair was done in 24 patients, MV replacement - in 2 patients. Complete revascularization was achieved in all cases. Mean number of distal anastomoses was 2 ± 0.93 (1; 4). Special exposure maneuvers, which are presented in the video, were used in every approach. There was no hospital or 30-days mortality. CONCLUSIONS:Concomitant MVR and bypass grafting without sternotomy is a viable option for selected patients. Right minithoracotomy, left minithoracotomy or bilateral minithoracotomies could be used for these concomitant procedures depending on the extent of coronary revascularization, complexity of MVR, surgical expertise and experience.
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