Minimally Invasive Surgical Valve Repair
DOI:
https://doi.org/10.1532/HSF98.20091145Abstract
Background: Minimal-access valve repair was introduced in the 1990s and is becoming an accepted option for patients undergoing valve surgery. Minimally invasive surgical valve repair reduces the degree of surgical insult, produces less postoperative pain, uses less blood, and is associated with better cosmetic results.
Methods: Between July 2008 and February 2009, 17 cardiac surgical patients were treated with minimally invasive valve repair at 3 different institutions (Royal Spanish Hospital, Portuguese Hospital, and Cardio Pulmonar Institute, Salvador, Brazil). The heart was accessed via an incision between the ribs in the second or third intercostal space. A retrospective analysis was performed on the outcomes in the first 24 postoperative hours in the intensive care unit and on the fourth postoperative day before the patient's discharge from the hospital.
Results: Of the 17 patients who underwent minimally invasive valve repair and were evaluated, 8 patients (47.05%) underwent aortic surgery, 4 patients (23.52%) underwent mitral valve surgery, 4 patients (23.52%) underwent surgery for a congenital heart defect, and 1 patient (5.88%) underwent endocarditis treatment. The duration of cardiopulmonary bypass (CPB) was <120 minutes in all cases (median interval between lowest and highest CPB times, 90 minutes), and all cross-clamp times were <100 minutes (median interval between lowest and highest cross-clamp times, 70 minutes). There were no cases of reoperation for bleeding, incision infection, or myocardial infarction. The median hospital stay was 5 days; the operative mortality rate was 5.8%.
Conclusion: We conclude that by avoiding full sternotomy, the approach of minimal surgical access contributes to an improved postoperative stability of the chest and less surgical pain. On the other hand, the limited exposure of the heart is a disadvantage of minimally invasive valve repair. Minimally invasive surgical valve repair is safe and feasible with excellent outcomes and is well tolerated in the elderly. Care must be taken to follow the learning curve for operation duration and to treat surgical complications.
References
Cosgrove DM 3rd, Sabik JF. 1996. Minimally invasive approach for aortic valve operations. Ann Thorac Surg 62:596-7.nCohn LH, Adams DH, Couper GC, et al. 1997. Minimally invasive cardiac valve surgery improves patient satisfaction while reducing costs of cardiac valve replacement and repair. Ann Surg 226:421-8.nMihaljevic T, Cohn LH, Uric D, Aranki SF, Couper GS, Byrne JG. 2004. One thousand minimally invasive valve operations: early and late results. Ann Surg 240:529-34.nStamou SC, Kapetanakis EL, Lowery R, Jablonski KA, Frankel TL, Corso PJ. 2003. Allogeneic blood transfusion requirements after minimally invasive versus conventional aortic valve replacement: a riskadjusted analysis. Ann Thorac Surg 76:1101-6.nSzwerc MF, Benckart DH, Wiechmann RJ, Savage EB, Szydlowski GW, Magovern GJ Jr, Magovern JA. 1999. Partial versus full sternotomy for aortic valve replacement. Ann Thorac Surg 68:2209-14.n
