American Surgical Association

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Minimally Invasive Mitral Valve Surgery Expands the Surgical Options for High-Risks Patients
Michael R Petracek, MD*, Marzia Leacche, MD*, Natalia S Solenkova, MD*, Ramanan Umakanthan, MD*, Rashid M Ahmad, MD*, Stephen K Ball, MD*, Steven J Hoff, MD*, Tarek S Absi, MD*, Jorge M Balaguer, MD*, John G Byrne, MD
Vanderbilt University Medical Center, Nashville, TN

OBJECTIVES: A simplified minimally invasive mitral valve surgery (MIMVS) approach avoiding cross-clamping and cardioplegic myocardial arrest using a small (5 cm) right antero-lateral incision was developed. We hypothesized that in high-risk patients this approach would decrease myocardial ischemia and yield to superior results compared to those predicted by the Society of Thoracic Surgeons (STS) algorithm for standard median sternotomy mitral valve surgery.
METHODS: Five hundred and four consecutive patients (249M/255F), median age 65 years (range 20-92 years) underwent MIMVS between 1/06-8/09. Median preoperative New York Heart Association function class was 3 (range 1-4). Eighty-two (16%) patients had an ejection fraction <35%. Forty-seven (9%) had a STS predicted mortality > 10%. Under cold fibrillatory arrest (median temperature 28 °C) without aortic cross-clamp, mitral valve repair (224/504, 44%) or replacement (280/504, 56%) was performed.
RESULTS: Thirty-day mortality for the entire cohort was 2.2% (11/504). In patients with a STS predicted mortality > 10%, the observed 30-day mortality was 4% (2/47), lower than the mean STS predicted mortality of 20%. Morbidity in this high-risk group was equally low: 1/47 (2%) patients underwent re-exploration for bleeding, 1/47 (2 %) patients suffered a permanent neurologic deficit, none had mediastinal infection. The median length of stay was 8 days (range 1-68 days).
CONCLUSIONS: This study demonstrates that MIMVS without aortic cross-clamp is reproducible with low mortality and morbidity rates. This approach expands the surgical options for high-risk patients and yields to superior results compared to the conventional median sternotomy approach.


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