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Mitral Valve Surgery And Coronary Revascularization Via The Left Anterior Minithoracotomy
Dmytro Babliak, Oleksandr Babliak, Serhii Yatsuk.
Diagnostic and Treatment Center for Children and Adults, Dobrobut Medical Network, Kyiv, Ukraine.
BACKGROUND: To analyze the results of simultaneous mitral valve (MV) surgery and coronary artery bypass grafting (CABG) through a single left anterior minithoracotomy.
METHODS: Between October 2020 and December 2024, 59 non-consecutive patients underwent simultaneous MV surgery and CABG via a left anterior minithoracotomy. The mean patient age was 64.6 ± 8.8 years (range: 40-80), with a mean body surface area of 1.9 ± 0.18 m² (range: 1.6-2.3) and a mean left ventricular ejection fraction of 43.5 ± 12.6% (range: 20-60). Preoperative computed tomography angiography was routinely performed.
The procedure involved peripheral cardiopulmonary bypass (CPB), aortic cross-clamping, and cold blood cardioplegia. Surgical access was achieved via a 6-8 cm incision in the 4th intercostal space on the left anterior side. The MV was approached through the right atrium and interatrial septum. Conventional techniques were used for MV repair/replacement. Distal coronary anaMV intervention was performed after distal anastomoses, followed by left internal mammary artery (LIMA) grafting.
RESULTS: Mitral valve visualization was successful in all patients, and no conversions to sternotomy were required. MV replacement was performed in 9 patients (15.3%), MV repair - 50 patients (84.7%). In MV repair different techniques were applied, including ring (37 patients), semiring (12 patients), and artificial chordae insertion (6 patients). Complete coronary revascularization was achieved in all patients, with an average of 2.3 ± 0.95 distal anastomoses per patient (range: 1-4).
The mean total operation time was 332.9 ± 47.2 minutes (range: 240-420), CPB time was 220.9 ± 41 minutes (range: 148-320), and cross-clamp time was 125 ± 25.6 minutes (range: 74-177). Patients stayed in the ICU for an average of 1.6 ± 0.65 days (range: 1-4) and the total hospital stay was 6.7 ± 1.9 days (range: 4-14). No significant bleeding, strokes, major complications, hospital mortality, or 30-day mortality were observed.
CONCLUSIONS: Simultaneous MV surgery and CABG via a single left anterior minithoracotomy incision is technically feasible, provides complete revascularization, different MV repair techniques application and safe outcomes.
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