A Simple Approach for Minimally Invasive Combined Aortic and Mitral Valve Surgery

Abstract

Background There is now extension of minimally invasive techniques to involve concomitantly aortic and mitral valves through a single small incision. We share our experience in such surgeries through upper partial sternotomy with approaching the mitral valve through the dome of the left atrium.

Methods Two matched groups of cases receiving concomitant aortic and mitral valve surgeries are compared regarding the surgical outcomes: the minimally invasive group (group A) including 72 patients and the conventional group (group B) including 78 patients.

Results The mean age was 52 ± 8 years in group A and 53 ± 7 years in group B. Males represented (42%) in group A and (49%) in group B. The mean mechanical ventilation time was significantly shorter in group A (4.3 ± 1.2 hours) than in group B (6.1 ± 0.8 hours) with a p-value of 0.001. In addition, the amount of chest tube drainage and the need for blood transfusion units were significantly less in group A (250 ± 160 cm³ and 1.3 ± 0.8 units, respectively) when compared with group B (320 ± 180 cm³ and 1.8 ± 0.9 units, respectively) with p-values of 0.013 and 0.005, respectively. Over a follow-up period of 3.2 ± 1.1 years, one mortality occurred in each group with no significant difference (p-value = 0.512).

Conclusion Combined aortic and mitral valve surgery through upper partial sternotomy with approaching the mitral valve through the dome of the left atrium is safe and effective with the advantages of less postoperative blood loss, need for blood transfusion, and mechanical ventilation time compared with conventional aortic and mitral valve surgery.

Keywords

heart valve surgery - minimally invasive surgery - ministernotomy - sternum - mitral valve surgery - aorta/aortic

Publikationsverlauf

Eingereicht: 25. Juli 2021

Angenommen: 01. September 2021

Artikel online veröffentlicht:
28. Dezember 2021

• References

• 1 Goldstone AB, Joseph Woo Y. Minimally invasive surgical treatment of valvular heart disease. Semin Thorac Cardiovasc Surg 2014; 26 (01) 36-43
• 2 Lio A, Miceli A, Ferrarini M, Glauber M. Minimally invasive approach for aortic and mitral valve surgery. Eur J Cardiothorac Surg 2016; 50 (06) 1204-1205
• 3 Lamelas J, Mawad M, Williams R, Weiss UK, Zhang Q, LaPietra A. Isolated and concomitant minimally invasive minithoracotomy aortic valve surgery. J Thorac Cardiovasc Surg 2018; 155 (03) 926-936.e2
• 4 Alkady H. Minimally invasive mitral valve surgery: an update. Int J Cardiovasc Thoracic Surg 2017; 3: 32-40
• 5 Gammie JS, Zhao Y, Peterson ED, O'Brien SM, Rankin JS, Griffith BPJ. J. Maxwell Chamberlain Memorial Paper for adult cardiac surgery. Less-invasive mitral valve operations: trends and outcomes from the Society of Thoracic Surgeons Adult Cardiac Surgery Database. Ann Thorac Surg 2010; 90 (05) 1401-1408 , 1410.e1, discussion 1408–1410
• 6 Glauber M, Ferrarini M, Miceli A. Minimally invasive aortic valve surgery: state of the art and future directions. Ann Cardiothorac Surg 2015; 4 (01) 26-32
• 7 Vola M, Fuzellier J-F. Extending minimally invasive approaches to concomitant aortic and mitral valve surgery: are we ready?. Eur J Cardiothorac Surg 2016; 50 (06) 1206-1207
• 8 Atik FA, Svensson LG, Blackstone EH, Gillinov AM, Rajeswaran J, Lytle BW. Less invasive versus conventional double-valve surgery: a propensity-matched comparison. J Thorac Cardiovasc Surg 2011; 141 (06) 1461-8.e4
• 9 Lamelas J. Minimally invasive concomitant aortic and mitral valve surgery: the “Miami Method”. Ann Cardiothorac Surg 2015; 4 (01) 33-37
• 10 Zhao D, Wei L, Zhu S. et al. Combined mitral and aortic valve procedure via right mini-thoracotomy versus full median sternotomy. Int Heart J 2019; 60 (02) 336-344
• 11 Minh TH, Mazine A, Bouhout I. et al. Expanding the indication for sutureless aortic valve replacement to patients with mitral disease. J Thorac Cardiovasc Surg 2014; 148 (04) 1354-1359
• 12 Gilmanov D, Miceli A, Bevilacqua S. et al. Sutureless implantation of the perceval s aortic valve prosthesis through right anterior minithoracotomy. Ann Thorac Surg 2013; 96 (06) 2101-2108
• 13 Svensson LG. Minimally invasive surgery with a partial sternotomy “J” approach. Semin Thorac Cardiovasc Surg 2007; 19 (04) 299-303
• 14 Sun H-S, Ma W-G, Xu J-P, Sun L-Z, Lu F, Zhu X-D. Minimal access heart surgery via lower ministernotomy: experience in 460 cases. Asian Cardiovasc Thorac Ann 2006; 14 (02) 109-113
• 15 Modi P, Chitwood Jr WR. Retrograde femoral arterial perfusion and stroke risk during minimally invasive mitral valve surgery: is there cause for concern?. Ann Cardiothorac Surg 2013; 2 (06) E1
• 16 Légaré JF, Buth KJ, Arora RC, Murphy DA, Sullivan JA, Hirsch GM. The dome of the left atrium: an alternative approach for mitral valve repair. Eur J Cardiothorac Surg 2003; 23 (03) 272-276
• 17 Faerber G, Tkebuchava S, Scherag A. et al. Right mini-thoracotomy for aortic plus mitral with or without tricuspid valve surgery. Thorac Cardiovasc Surg 2020
• 18 Totaro P, Carlini S, Pozzi M. et al. Minimally invasive approach for complex cardiac surgery procedures. Ann Thorac Surg 2009; 88 (02) 462-466 , discussion 467
• 19 Shin H, Yozu R, Higashi S, Kawada S. Sinus node function after mitral valve surgery using the superior septal approach. Ann Thorac Surg 2001; 71 (02) 587-590
• 20 Mihaljevic T, Cohn LH, Unic D, Aranki SF, Couper GS, Byrne JG. One thousand minimally invasive valve operations: early and late results. Ann Surg 2004; 240 (03) 529-534 , discussion 534