Minimally invasive beating heart technique for redo mitral valve surgery in patients with giant left ventricle

Abstract

KEYWORDSMinimally invasive, Beating heart technique, Redo mitral valve surgery, Giant left ventricle 2 Abstract Purpose: To analyze the feasibility and efficacy of minimally invasive beating heart technique for redo mitral valve surgery in the cardiac patients with giant left ventricle. Methods: Eighty cardiac patients with giant left ventricle according to the diagnostic criteria that left ventricular end diastolic diameter (LVEDD) was ≥70 mm,who underwent redo 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 thoracotomy arrested heart technique group (n=50) according to the surgical methods. Preoperative, intraoperative, and postoperative variables were compared between two groups. Results: Minimally invasive beating heart technique compared to the conventional median thoracotomy arrested heart technique for redo mitral valve surgery in the cardiac patients with giantleft 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 six months postoperative echocardiographic parameters. Conclusions: Using the method of minimally invasive beating heart technique for redo mitral valve surgery in the cardiac patients with giant left ventricle is feasible, effective, reliable and cosmetic, 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. BackgroundWith the increasing number of cardiac surgery, more and more cases of mitral valve reoperations are made because of various reasons, such as perivalvular leakage, prosthesis dysfunction, rheumatic valve disease, infective endocarditis, perivalvular tissue hyperplasia, bioprosthetic valve decay. These patients tend to have a long course of disease, this could eventually lead to left ventricular Zhengzhou,450052,

A Potential Marker for Prognosis in Giant Left Ventricular Patients Undergoing Valve Surgery

“…According to the 2005 American Society of Echocardiography standards, there are four categories of left ventricular size: normal, mildly enlarged, substantially enlarged, and severely enlarged [9]. Han et al [3] studied the factors associated with the outcome of giant LV valve replacement surgery, and all 55 patients with chronic rheumatic heart disease with LVEDD ≥70 mm underwent mechanical valve replacement. The perioperative mortality rate increased significantly to 8.8% [3], indicating that a giant left ventricle is an important factor in perioperative mortality [6,7].…”

“…Han et al [3] studied the factors associated with the outcome of giant LV valve replacement surgery, and all 55 patients with chronic rheumatic heart disease with LVEDD ≥70 mm underwent mechanical valve replacement. The perioperative mortality rate increased significantly to 8.8% [3], indicating that a giant left ventricle is an important factor in perioperative mortality [6,7]. In previous studies, the researchers preferred to assess left ventricular changes by ultrasound, but there are no standardized parameters of left ventricular function [10].…”

“…Patients with a giant left ventricular and heart valve disease have a left ventricular end-diastolic diameter (LVEDD) ≥65 mm [1]. Incomplete statistics have demonstrated a 5-year mortality rate of 20% [2], and surgery is the recommended approach for the management of giant left ventricular valve disease patients [3,4]. However, the efficacy of surgery is still a difficult problem that influences the best surgical opportunity [5].…”