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Concomitant Mitral Valve And Thoracic Aorta Repair Via Upper Mini-sternotomy
Eduard Charchyan1, Denis Breshenkov
2, Yuriy Belov
2;
1Petrovsky National Research Centw of Surgery, Moscow, Russian Federation,
2Petrovsky National Research Centre of Surgery, Moscow, Russian Federation
BACKGROUND: to present the experience of concomitant treatment of mitral valve pathology in minimally invasive treatment of thoracic aortic diseases.
METHODS: from July 2016 to December 2023, 353 minimally invasive thoracic aorta repair were performed via J-shaped upper mini-sternotomy, of them 26 patients with concomitant mitral valve repair. Study endpoints included in-hospital mortality, early outcomes and complications. Follow up survival was presented using the Kaplan-Meier method.
RESULTS: Fifteen patients (57.7%) had the aortic root aneurysm with aortic regurgitation, 10 (38.5%) - degenerative aortic valve lesion with ascending aortic aneurysm and one patient (6.3 %) - subacute type A aortic dissection. In all cases, the indication for mitral valve intervention was severe regurgitation. The biatrial transseptal Guiradon approach was used in 14, (53,9%), in 12 cases (46,1%) we used approach through the roof of the left atrium (n=2, 12.5%). Blood cardioplegia by Calafiori was used in 10 cases (38.5%), pharmacocold with Custodiol solution in 6 cases (23%), in other cases we used DelNido solution (n=10, 38,5%). The David procedure was performed in 8 cases (30,7%), the Bentall-DeBono procedure - in 10 (38,5%) cases, supracoronary ascending aorta replacement with aortic valve replacement - in 8 (30,7%) cases. Mitral valve replacement was performed in 8 cases (30.7%), in other cases we performed mitral valve repair: in 8 patients (30.7%) ring annuloplasty, in 5 cases (19.2%) suture annuloplasty by Batista, triangular resection of the posterior leaflet in 4 cases (15.4%) and in one case neochordae (3.8%) was used. Concomitant tricuspid valve repair was performed in 3 case (11.5%), reduction atrioplasty in 8 cases (30.7%), left appendage resection in 10 cases (38.5%), Maze procedure in 4 cases, in 1 case a FET procedure was performed (6 .3%). Cardiopulmonary bypass time, aortic cross-clamp time, and blood loss were 161.7 ± 33.5 min, 138.6 ± 30.4 min, and 800 (625-925) ml, respectively. Mean ICU stay was 1 (1-2) days, hospital stay was 10 (9.75-12) days. In-hospital mortality was n = 1, 3.8%, in a patient with subacute type I aortic dissection secondary to developed multiple organ failure and sepsis. In 1 (3.8%) case, respiratory failure was observed. In 2 cases (7.7%) a transient AV block developed, in 1 case (3.8%) a permanent AV block occurred, requiring the pacemaker. The 5-year survival rate was 86%, freedom from reoperations was 100%.
CONCLUSIONS: With the rapid development and growing popularity of minimally invasive surgery, the indications and possibilities for concomitant surgery, including atrioventricular valves and thoracic aorta, are expanding. This approach can provide satisfactory results, and obtain found for improving of results by reducing surgical trauma with a minimally invasive technique.Upper J-shaped mini-sternotomy is a safe, effective and reproducible minimally invasive technique in patients with concomitant thoracic aorta and mitral valve pathologies.
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