Abstract
PurposeTo analyze the efficacy of minimally invasive beating heart technique for mitral valve surgery in the cardiac patients with previous sternotomy and giant left ventricle.MethodsEighty cardiac patients with previous sternotomy and giant left ventricle according to the diagnostic criteria that left ventricular end diastolic diameter (LVEDD) was ≥70 mm, who underwent mitral valve surgery at our center from January 2006 to January 2019 were analyzed. We divided all patients into minimally invasive beating heart technique group (n = 30) and conventional median resternotomy arrested heart technique group (n = 50) according to the surgical methods. Preoperative, intraoperative, and postoperative variables were compared between two groups.ResultsMinimally invasive beating heart technique compared to the conventional median resternotomy arrested heart technique for mitral valve surgery in the cardiac patients with previous sternotomy and giant left ventricle had significant differences in operation time(P = 0.002), cardiopulmonary bypass (CPB) time(P < 0.001), intraoperative blood loss(P < 0.001), postoperative transfusion ratio(P = 0.01), postoperative transfusion amount(P < 0.001), postoperative drainage volume(P = 0.001), extubation time(P = 0.04), intensive care unit (ICU) stay time(P = 0.04) and postoperative hospital stay time(P < 0.001), but no significant differences in re-exploration for bleeding, postoperative 30-day mortality, postoperative complications and 6 months postoperative echocardiographic parameters.ConclusionsUsing the method of minimally invasive beating heart technique for mitral valve surgery in the cardiac patients with previous sternotomy and giant left ventricle is effective and reliable, meanwhile reduce the operation time and CPB time, decrease the transfusion ratio and transfusion amount, shorten postoperative ICU stay and hospital stay time, promote the early extubation so that accelerate the patients’ early recovery.All of these show a benefit of minimally invasive beating heart technique compared to conventional median resternotomy arrested heart technique.
Highlights
With the increasing number of cardiac surgery, more and more cases of mitral valve reoperations are made because of various reasons.These reoperation patients tend to have a long course of disease, this could eventually lead to left ventricular enlargement and poor cardiac function
In the median resternotomy arrested heart group, ascending aortic cannulation was used in 88.0% of patients (n = 44), and 6 patients (12%) underwent femoral arterial cannulation
The most of patients for redo mitral valve surgery were performed mitral valve replacement (MVR) (86.7% vs 86.0%, P = 0.93)
Summary
With the increasing number of cardiac surgery, more and more cases of mitral valve reoperations are made because of various reasons.These reoperation patients tend to have a long course of disease, this could eventually lead to left ventricular enlargement and poor cardiac function. The beating heart technique can interfere with the mechanisms of ischemia-reperfusion injury [8, 9] that may be advantageous in patients with poor left ventricular functions [10,11,12,13,14]. Not seen minimally invasive beating heart technique for redo mitral valve surgery in patients with giant left ventricle at home and abroad for details. We analyze primarily the efficacy of minimally invasive beating heart technique by comparing the preoperative, intraoperative, and postoperative variables of conventional median resternotomy arrested heart technique for mitral valve surgery in the cardiac patients with previous sternotomy and giant left ventricle
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