2. Minimally invasive mitral valve surgery why do you take the risks?

Abstract

During recent years, minimally invasive mitral valve surgery (MIMVS) become the preferred method of mitral valve repair and replacement in many institutions worldwide with excellent results, in spite of there is no clear difinition of minimally invasive surgery and we do not have efficient studies about the risks of MIMVS comparing to conventional mitral valve surgery. Many studies are needed to clarify the need for either conventional or minimally invasive mitral valve surgery instead of personal preference. The patient’s demographic profile, intraoperative data and postoperative outcomes of patients undergoing minimally invasive mitral valve surgery were retrospectively collected from our database from May 2011 to April 2014. We will present early and mid-term outcomes of patients undergoing minimally invasive mitral valve surgery in our institution. Seventy consecutive patients (45 male and 25 female), age 35 ± 12 years, underwent MIMVS surgery. Mean preoperative New York Heart Association function class was 2.6 ± 0.7. Mean ejection fraction was 50 ± 8. Cardiopulmonary bypass was instituted through femoral cannulation (28 of 70, 40%), or direct aortic cannulation (42 of 70, 25%). Aortic cross-clamp used in (66 of 70, 94.2%). Without aortic cross-clamp in (4 of 70, 5.7%), mitral valve repair has been done in (52 of 70, 74.2%), mitral valve replacement (18 of 70, 25.7%). Concomitant procedures included AF ablation (24 of 70, 34.2%), and tricuspid valve repair (33 of 70, 47.1%). No mortality recorded, residual mitral regurge was found in (6 of 70, 8.5%) during 1 year follow up. Cardiopulmonary bypass, and “skin to skin” surgery were 95 ± 35 and 250 ± 74 min, respectively. 4 patients (5.7%) underwent reexploration for bleeding and (57 of 70, 81.4%) did not receive any blood transfusions. Six patients (8.5%) sustained face oedema. Mean length of hospital stay was 7 ± 3.8 days. 18 patients (25.7%) did not feel any interest regarding cosmotic advantage over conventional surgery. Minimally invasive mitral valve surgery is an excellent alternative to conventional mitral valve surgery in most cases however comparing to conventional mitral surgery it shows long bypass time, long cross clamp time, difficult reexploration for bleeding and multiple body incisions.