Quality of mitral valve repair: Median sternotomy versus port-access approach

Raanani, Ehud; Spiegelstein, Dan; Sternik, Leonid; Preisman, Sergey; Moshkovitz, Yaron; Smolinsky, Aram; Shinfeld, Amihai

doi:10.1016/j.jtcvs.2009.09.035

Cited by 51 publications

(62 citation statements)

References 17 publications

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“…Although there have been several reports focused on comparing the long-term freedom from reoperation between MICS and sternotomy, few studies demonstrated the long-term quality of the repaired MV (regurgitation or stenosis) and freedom from significant MR based on long-term regular echocardiographic follow-up. [8][9][10] In addition, previous studies have limitations for comparing outcomes between 2 groups, with significant differences in baseline characteristics. We, therefore, sought to compare the longterm clinical and echocardiographic outcomes of MV repair performed through a minithoracotomy versus a traditional sternotomy in a homogeneous population with degenerative MR using inverse-probability-of-treatment weighting (IPTW) to reduce baseline differences.…”

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confidence: 99%

Echocardiographic assessment of mitral durability in the late period following mitral valve repair: Minithoracotomy versus conventional sternotomy

Yoo

Kim

Jung

et al. 2014

The Journal of Thoracic and Cardiovascular Surgery

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confidence: 99%

Echocardiographic assessment of mitral durability in the late period following mitral valve repair: Minithoracotomy versus conventional sternotomy

Yoo

Kim

Jung

et al. 2014

The Journal of Thoracic and Cardiovascular Surgery

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“…Recent meta-analyses find comparable or superior results for the MICS approach [2,3]. A specific analysis of results in the elderly population is usually lacking, as most results either do not address this age group separately or include predominantly younger patients [4].…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive mitral valve surgery in the old patient

et al. 2011

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Zusammenfassung. Grundlagen: Die minimal invasive Operation der Mitralklappe ist heute eine bewährte Alternative zur konventionellen Operation durch mediane Sternotomie. Trotzdem bleibt unklar, inwieweit die objektiven Vorteile von Kosmetik, Blutverlust, Intensivstations-und Krankenhausaufenthalt sowie Wiederaufnahme der Arbeit auch bei älteren Patienten zum Tragen kommen oder vielleicht durch zusätzliche Komplikationen mit erhöhter Morbidität und Mortalität aufgewogen werden. Darü ber hinaus bleibt die Frage ungeklärt, ob diejenigen Erkrankungen, welche bei älte-ren Menschen vorwiegend gefunden werden, mit der minimal invasiven Methode ü berhaupt angegangen werden können. Methodik: Patienten über 75 Jahre, die in unserer Anteilung von 2001-2009 eine minimal invasive Mitralklappenoperation erhalten hatten, wurden hinsichtlich Operationsart (isolierte Mitralklappenoperation oder Kombination mit Trikuspidalklappenoperation oder Vorhofsablation bei Vorhofflimmern), perioperative Mortalität und intraoperativen Komplikationen untersucht. Die Ergebnisse werden der neueren Literatur gegenübergestellt. Ergebnisse: Von 2001 bis 2009 wurden von insgesamt 253 minimal invasiven Mitralklappenoperationen 30 % bei Patienten über 70, 14 % über 75 und 4 % über 80 Jahre durchgeführt. Die Mortalität betrug 1,3 % bei den älteren Patienten, gegenüber 0,8 % in der Gesamtpopulation. Der Anteil von Klappenersatzoperationen war bei den älteren Patienten gleich wie bei den jüngeren (11 % vs. 12,4 %).Schlussfolgerungen: Anders als der Aortenklappenersatz werden minimal invasive Mitralklappenoperationen nur in einem relativ kleinen Prozentsatz bei älteren Patienten durchgefü hrt. Auf Grund unserer Ergebnisse können minimal invasive Operationen jedoch auch bei älteren Patienten mit ausgezeichneten Ergebissen durchgefü hrt werden. Daten aus der rezenten Literatur bestäti-gen diesen Schluss. Eine Verminderung des chirurgischen Traumas fü hrt auch bei älteren Patienten nicht nur zu verbesserten kosmetischen Ergebnissen, sondern ist auch sicher.Schlüsselwörter: Minimal invasive Mitralklappenoperation, ältere Patienten.Summary. Background: Minimally invasive (MICS) mitral valve surgery has become a valid alternative to the conventional approach by full median sternotomy; nevertheless, it remains unclear if the benefits, which comprehend mainly cosmesis, blood loss, ICU time, hospital stay and return to work also are true for the elderly population and may not be offset by additional complications resulting in an increased morbidity and mortality. Moreover the question remains if the diseases prevailing in the elderly population can be approached by the minimally invasive technique.Methods: Patients 75 years or older treated in our institution from 2001 to 2009 by MICS mitral valve surgery are analyzed in respect to type of surgery (isolated mitral valve surgery or combined with tricuspid or atrial fibrillation surgery), perioperative mortality and intraoperative complications. The results are related to recent literature.Results: Out of 253 MICS ...

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“…This has resulted in excellent success rates and allows operating on higher risk groups including those with left ventricular dysfunction and reoperative scenarios. [6][7][8][9][10][11][12][13] While a very small number of centers have applied robotic technology and achieved equivalent results in the setting of posterior leaflet pathology, 14 a recent review echoes the voice of the majority of cardiac surgeons. In sharp contrast to urologic and obstetric surgery, the logistic, financial, and other constraints of the current generation of robotic technology have limited this approach.…”

Section: The Minimally Invasive Eramentioning

confidence: 99%

What's New in Mitral Valve Repair?

DiBardino

Farivar

2017

Journal of the Minneapolis Heart Institute Foundation

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Mitral valve repair is the standard of care for degenerative mitral valve pathology, as established by the median sternotomy approach. Equivalently excellent results can be achieved by a variety of more minimally invasive approaches depending on institutional experience and preferences. At the Minneapolis Heart Institutet, we have experience with and utilize all approaches to mitral valve repair for degenerative disease including full and hemisternotomy, right thoracotomy, mini-thoracotomy and heart port approaches. We believe that logistic, economic, and anticipated benefit constraints currently limit the application and the robotic technology. Leaflet maneuvers continue to be important in mitral valve repair, but recently we have revisited the concept of simplifying a ''complex'' repair in the setting of a subset of severe degenerative (Barlow's) disease by utilizing only an oversized mitral valve ring with excellent results. As suggested by others, in the appropriate setting of bileaflet prolapse resulting in central symmetric regurgitation, a simplified approach may be just as effective as longer, more complicated operations. 1. Degenerative MV disease can be repaired in the majority of cases with a durable long-term result and very low reoperative rate. Experienced centers can reproducibly expect repair rates of over 90% with a 1% failure rate/year. 2. The life expectancy curves for those that undergo repair approach those of the normal life expectancy curves for men and women, and in certain cases may be better than twins without the disease. 3. The repair techniques include a finite list of leaflet maneuvers and should always include the placement of a ring for annular fixation. The leaflet maneuvers include various resections, plications, commissure, and cleft closures; edge-toedge repairs; and artificial chord placement based upon the findings of the echo and the appearance of the degenerative pathology at the time of surgery. KEY WORDSGiven the evolution and success of these surgical tenets, the American College of Cardiology/American Heart Association guidelines have recommended MV surgery for symptomatic MR and minimally symptomatic MR in the presence of left ventricular dilation or dysfunction, and-at centers of excellence-can be considered for asymptomatic patients. Secondary to these recommendations, an estimated 40,000 MV operations take place in the US per year; given the low prevalence of rheumatic disease in the US, the majority of these patients are sent to surgery with MR and the majority of them are potential candidates for MV repair rather than replacement.

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Quality of mitral valve repair: Median sternotomy versus port-access approach

Abstract: In isolated posterior mitral valve pathology, quality of mitral valve repair with the port-access approach can compare with that with the conventional median sternotomy approach.

Cited by 51 publications

References 17 publications

Echocardiographic assessment of mitral durability in the late period following mitral valve repair: Minithoracotomy versus conventional sternotomy

Echocardiographic assessment of mitral durability in the late period following mitral valve repair: Minithoracotomy versus conventional sternotomy

Minimally invasive mitral valve surgery in the old patient

What's New in Mitral Valve Repair?

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