Thorac Cardiovasc Surg 2019; 67(07): 524-530
DOI: 10.1055/s-0038-1667144
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Mitral Valve Surgery via Partial Upper Sternotomy: Closing the Gap between Conventional Sternotomy and Right Lateral Minithoracotomy

Cenk Oezpeker
1   Department of Cardiac Surgery, Landeskrankenhaus Innsbruck Universitatskliniken, Innsbruck, Austria
,
Fabian Barbieri
1   Department of Cardiac Surgery, Landeskrankenhaus Innsbruck Universitatskliniken, Innsbruck, Austria
,
Daniel Hoefer
1   Department of Cardiac Surgery, Landeskrankenhaus Innsbruck Universitatskliniken, Innsbruck, Austria
,
Bastian Schneider
1   Department of Cardiac Surgery, Landeskrankenhaus Innsbruck Universitatskliniken, Innsbruck, Austria
,
Nikolaos Bonaros
1   Department of Cardiac Surgery, Landeskrankenhaus Innsbruck Universitatskliniken, Innsbruck, Austria
,
Michael Grimm
1   Department of Cardiac Surgery, Landeskrankenhaus Innsbruck Universitatskliniken, Innsbruck, Austria
,
Ludwig Mueller
1   Department of Cardiac Surgery, Landeskrankenhaus Innsbruck Universitatskliniken, Innsbruck, Austria
› Author Affiliations
Sources of Funding None.
Further Information

Publication History

27 March 2018

13 June 2018

Publication Date:
04 September 2018 (online)

Abstract

Background Minithoracotomy (MT) has gained broad acceptance for mitral valve surgery (MVS) in the last decade. In the presence of defined limitations of MT, however, full sternotomy (FS) is still widely preferred. We assume that the less investigated partial upper sternotomy (PS) will permit the gap between MT and FS in MVS to be closed. The purpose of this study is to investigate a valid less invasive alternative to MT for isolated MVS or multivalve surgery.

Methods This retrospective analysis includes data on 1,639 patients, who underwent either isolated or combined primary MVS at our department from May 2011 to August 2017. Out of these, 663 patients were operated via MT access. One-hundred three patients had been judged as not suitable for MT but feasible for PS approach in which 53.4% (n = 55) had isolated MVS and 46.6% patients (n = 48) underwent multivalve surgery. Concomitant myocardial revascularization was performed in 2.9% of the study patients (n = 3).

Results Operative, 90-day, and 1-year mortality in the PS-cohort was 0, 1.0% (n = 1), and 3.3% (n = 3), respectively. During a median follow-up time of 1,115 days (interquartile range 398–1806), all-cause mortality was 5.8% (n = 6). Operative times for cardiopulmonary-bypass and cross-clamping were 167 minutes (140–198) and 107 minutes (93–132), respectively. Median length of stay at the intensive care unit and hospital was 1 (1–2) and 7 days (7–10), respectively.

Conclusion The presented results demonstrate that there is a cohort of patients, who are not candidates for MT in MVS but may be operated successfully by an alternative less invasive approach.

 
  • References

  • 1 Beckmann A, Funkat AK, Lewandowski J. , et al. German Heart Surgery Report 2016: The Annual Updated Registry of the German Society for Thoracic and Cardiovascular Surgery. Thorac Cardiovasc Surg 2017; 65 (07) 505-518
  • 2 Vollroth M, Seeburger J, Garbade J, Borger MA, Misfeld M, Mohr FW. Conversion rate and contraindications for minimally invasive mitral valve surgery. Ann Cardiothorac Surg 2013; 2 (06) 853-854
  • 3 Doenst T, Lamelas J. Do we have enough evidence for minimally-invasive cardiac surgery? A critical review of scientific and non-scientific information. J Cardiovasc Surg (Torino) 2017; 58 (04) 613-623
  • 4 Meyer BW, Verska JJ, Lindesmith GG, Jones JC. Open repair of mitral valve lesions: the superior approach. Ann Thorac Surg 1965; 1: 453-457
  • 5 Gillinov AM, Cosgrove DM. Minimally invasive mitral valve surgery: mini-sternotomy with extended transseptal approach. Semin Thorac Cardiovasc Surg 1999; 11 (03) 206-211
  • 6 Risteski P, Monsefi N, Miskovic A. , et al. Triple valve surgery through a less invasive approach: early and mid-term results. Interact Cardiovasc Thorac Surg 2017; 24 (05) 677-682
  • 7 Svensson LG. Minimally invasive surgery with a partial sternotomy “J” approach. Semin Thorac Cardiovasc Surg 2007; 19 (04) 299-303
  • 8 Esposito G, Cappabianca G, Bichi S, Patrini D, Pellegrino P. Left atrial roof: an alternative minimal approach for mitral valve surgery. Innovations (Phila) 2012; 7 (06) 417-420
  • 9 Svensson LG, Atik FA, Cosgrove DM. , et al. Minimally invasive versus conventional mitral valve surgery: a propensity-matched comparison. J Thorac Cardiovasc Surg 2010; 139 (04) 926-32.e1 , 2
  • 10 Nagy ZL, Peterffy A. Minimally invasive aortic valve replacement: a word of caution. Ann Thorac Surg 2007; 84 (03) 1071 , author reply 1071–1072
  • 11 Lamelas J, Williams RF, Mawad M, LaPietra A. Complications associated with femoral cannulation during minimally invasive cardiac surgery. Ann Thorac Surg 2017; 103 (06) 1927-1932
  • 12 Lukac P, Hjortdal VE, Pedersen AK, Mortensen PT, Jensen HK, Hansen PS. Superior transseptal approach to mitral valve is associated with a higher need for pacemaker implantation than the left atrial approach. Ann Thorac Surg 2007; 83 (01) 77-82
  • 13 Reineke DC, Carrel TP. Less invasive left ventricular assist device implantation-a match changer!. J Thorac Dis 2015; 7 (05) 783-786
  • 14 Vlahakes GJ. Right ventricular failure after cardiac surgery. Cardiol Clin 2012; 30 (02) 283-289
  • 15 Rupprecht L, Schmid C. Deep sternal wound complications: an overview of old and new therapeutic options. Open J Cardiovasc Surg 2013; 6: 9-19
  • 16 Salenger R, Gammie JS, Collins JA. Minimally invasive aortic valve replacement. J Card Surg 2016; 31 (01) 38-50
  • 17 Shehada SE, Öztürk Ö, Wottke M, Lange R. Propensity score analysis of outcomes following minimal access versus conventional aortic valve replacement. Eur J Cardiothorac Surg 2016; 49 (02) 464-469 , discussion 469–470
  • 18 Doenst T, Diab M, Sponholz C, Bauer M, Färber G. The opportunities and limitations of minimally invasive cardiac surgery. Dtsch Arztebl Int 2017; 114 (46) 777-784