Mitral Valve Surgery via Upper Ministernotomy: Single-Centre Experience in More than 400 Patients.

Medhat Radwan,Aleksandra Miskovic,Tomas Holubec,Petar Risteski,Jan Hlavicka,Anton Moritz,Thomas Walther,Christoph Salewski,Florian Hecker

doi:10.3390/medicina57111179

Medhat Radwan, Aleksandra Miskovic + Show 7 more

Open Access

https://doi.org/10.3390/medicina57111179

Copy DOI

Abstract

Background: Minimally invasive mitral valve (MV) surgery has emerged as an alternative to conventional sternotomy aiming to decrease surgical trauma. The aim of the study was to describe our experience with minimally invasive MV surgery through partial upper sternotomy (PUS) regarding short- and long-term outcomes. Methods: From January 2004 through March 2014, 419 patients with a median age of 58.9 years (interquartile range 18.7; 31.7% females) underwent isolated primary MV surgery using PUS. Myxomatous degenerative MV disease was the predominant pathology (77%). The patients’ mean EuroSCORE II risk profile was 3.9 ± 3.6%. Results: Mitral valve repair was performed in 384 patients (91.6%) and replacement in 35 patients (8.4%). Thirty-day mortality was 3.1%. In total, 29 (6.9%) deaths occurred during the follow-up. The overall estimated survival at 1, 5, and 10 years was 93.1 ± 1.3%, 87.1 ± 1.9%, and 81.1 ± 3.4%. Reoperation was necessary in 14 (3.3%) patients. The overall freedom from MV reoperation at 1, 5, and 10 years was 98.2 ± 0.7%, 96.1 ± 1.2%, and 86.7 ± 6.7% and the overall freedom from recurrent MV regurgitation > grade 2 in repaired valves at 1, 5, and 10 years was 98.8 ± 0.6%, 98.8 ± 0.6%, and 94.6 ± 3.3%. Conclusions: Minimally invasive MV surgery via PUS can be performed with particularly good early and late results. Thus, the PUS approach with the use of standard surgical instruments and cannulation techniques can be a valuable option for the MV surgery either in patients contraindicated or not suitable to minithoracotomy.

Highlights

Invasive cardiac surgery continues to grow in popularity owing to improvements in surgical technique and technology, together with the acceptance of minimally invasive approaches for operations previously performed through a conventional median sternotomy [1,2,3,4]
A variety of minimally invasive approaches to the mitral valve (MV) have been developed in the early 1990s aiming to decrease the surgical trauma by minimizing the size of incisions and modifying the approach to the MV by avoiding a median sternotomy
Used MV repair techniques were triangular or quadrangular resection followed by artificial chord implantation accomplished by ring annuloplasty

Summary

Introduction

Invasive cardiac surgery continues to grow in popularity owing to improvements in surgical technique and technology, together with the acceptance of minimally invasive approaches for operations previously performed through a conventional median sternotomy [1,2,3,4]. A variety of minimally invasive approaches to the mitral valve (MV) have been developed in the early 1990s aiming to decrease the surgical trauma by minimizing the size of incisions and modifying the approach to the MV by avoiding a median sternotomy. These approaches include partial sternotomy (ministernotomy), parasternal incisions, minithoracotomy, and total endoscopic/robotic access [5,6,7,8,9]. Invasive mitral valve (MV) surgery has emerged as an alternative to conventional sternotomy aiming to decrease surgical trauma. The PUS approach with the use of standard surgical instruments and cannulation techniques can be a valuable option for the MV surgery either in patients contraindicated or not suitable to minithoracotomy

Objectives

Methods

Results

Discussion

Conclusion