Minimally Invasive Mitral Valve Surgery for Rheumatic Valve Disease
Background: The development of minimally invasive mitral valve surgery has created the motivation for using this approach in young patients with chronic rheumatic valve disease. We report our recent experience with patients undergoing minimally mitral valve surgery in this group of patients.
Methods: Between July 2014 and June 2018, 142 patients with rheumatic mitral valve dysfunction underwent minimally invasive surgery through a right thoracotomy approach at the University Medical Center of Ho Chi Minh City in Vietnam. Diagnosis was confirmed with transthoracic and transesophageal echocardiography (TTE and TEE). We analyzed the in-hospital and midterm follow-up outcomes of this group.
Results: The mean age was 42.6 ± 9.6 years. Sixty patients (42.3%) were male. Sixty-three patients were diagnosed with functional severe tricuspid regurgitation, 29 patients were identified with moderate tricuspid regurgitation, and tricuspid annulus was more than 21 mm/m²). Mitral valve repair was performed in 16 patients (11.3%), and 126 patients underwent mitral valve replacement. Mitral valve repair techniques included annuloplasty, leaflet peeling, and commissurotomy. Thirty-day mortality was 0.7%. Two patients had to be converted to conventional sternotomy, due to left atrial appendage laceration and mitral annular rupture. The overall survival rate was 98.6%. Freedom from reoperation was 97.1%.
Conclusions: In patients with rheumatic valve disease, minimally invasive mitral surgery safely and effectively can be performed with few perioperative complications and good midterm results.
Cheng DC, Martin J, Lal A, Diegeler A, Folliguet TA, Nifong LW, et al. 2011. Minimally invasive versus conventional open mitral valve surgery: a meta-analysis and systematic review. Innovations (Phila). 6(2):84-103.
Chopra HK, Nanda NC, Fan P, Kapur KK, Goyal R, Daruwalla D, et al. 1989. Can two-dimensional echocardiography and Doppler color flow mapping identify the need for tricuspid valve repair? J Am Coll Cardiol. 14(5):1266-74.
Chotivatanapong T, Lerdsomboon P, Sungkahapong V. 2012. Rheumatic mitral valve repair: experience of 221 cases from Central Chest Institute of Thailand. J Med Assoc Thai. 95 Suppl 8:S51-7.
Ding C, Jiang DM, Tao KY, Duan QJ, Li J, Kong MJ, et al. 2014. Anterolateral minithoracotomy versus median sternotomy for mitral valve disease: a meta-analysis. J Zhejiang Univ Sci B. 15(6):522-32.
Glauber M, Miceli A, Canarutto D, Lio A, Murzi M, Gilmanov D, et al. 2015. Early and long-term outcomes of minimally invasive mitral valve surgery through right minithoracotomy: a 10-year experience in 1604 patients. J Cardiothorac Surg. 10:181.
Jaine R, Baker M, Venugopal K. 2008. Epidemiology of acute rheumatic fever in New Zealand 1996-2005. J Paediatr Child Health. 44(10):564-71.
Lamelas J. 2015. Concomitant minithoracotomy aortic and mitral valve surgery: the minimally invasive "Miami Method". Ann Cardiothorac Surg. 4(1):85-7.
Luca F, van Garsse L, Rao CM, Parise O, La Meir M, Puntrello C, et al. 2013. Minimally invasive mitral valve surgery: a systematic review. Minim Invasive Surg. 179569.
Misfeld M, Borger M, Byrne JG, Chitwood WR, Cohn L, Galloway A, et al. 2013. Cross-sectional survey on minimally invasive mitral valve surgery. Ann Cardiothorac Surg. 2(6):733-8.
Modi P, Chitwood WR, Jr. 2013. Retrograde femoral arterial perfusion and stroke risk during minimally invasive mitral valve surgery: is there cause for concern? Ann Cardiothorac Surg. 2(6):E1.
Murzi M, Cerillo AG, Miceli A, Bevilacqua S, Kallushi E, Farneti P, et al. 2013. Antegrade and retrograde arterial perfusion strategy in minimally invasive mitral-valve surgery: a propensity score analysis on 1280 patients. Eur J Cardiothorac Surg. 43(6):e167-72.
Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, 3rd, Guyton RA, et al. 2014. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Thorac Cardiovasc Surg. 148(1):e1-e132.
Pfannmuller B, Davierwala P, Hirnle G, Borger MA, Misfeld M, Garbade J, et al. 2013. Concomitant tricuspid valve repair in patients with minimally invasive mitral valve surgery. Ann Cardiothorac Surg. 2(6):758-64.
Rozich JD, Carabello BA, Usher BW, Kratz JM, Bell AE, Zile MR. 1992. Mitral valve replacement with and without chordal preservation in patients with chronic mitral regurgitation. Mechanisms for differences in postoperative ejection performance. Circulation. 86(6):1718-26.
Schaff HV. 2015. Mitral valve repair in patients with rheumatic heart disease: what are the limits? J Thorac Cardiovasc Surg. 149(3):779-80.
Seeburger J, Borger MA, Falk V, Kuntze T, Czesla M, Walther T, et al. 2008. Minimal invasive mitral valve repair for mitral regurgitation: results of 1339 consecutive patients. Eur J Cardiothorac Surg. 34(4):760-5.
Sharma U, Tak T. 2011. Aortic atheromas: current knowledge and controversies: a brief review of the literature. Echocardiography. 28(10):1157-63.
Steer AC, Kado J, Jenney AW, Batzloff M, Waqatakirewa L, Mulholland EK, et al. 2009. Acute rheumatic fever and rheumatic heart disease in Fiji: prospective surveillance, 2005-2007. Med J Aust. 190(3):133-5.
Wang Z, Zhou C, Gu H, Zheng Z, Hu S. 2013. Mitral valve repair versus replacement in patients with rheumatic heart disease. J Heart Valve Dis. 22(3):333-9.
World Health Organ Tech Rep Ser. 2004. Rheumatic fever and rheumatic heart disease. 923:1-122, back cover.
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