Minimally Invasive Mitral Valve Surgery II

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Abstract

Techniques for minimally invasive mitral valve repair and replacement continue to evolve. This expert opinion, the second of a 3-part series, outlines current best practices for nonrobotic, minimally invasive mitral valve procedures, and for postoperative care after minimally invasive mitral valve surgery.

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Most cited references 15

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Minimally invasive cardiac valve surgery improves patient satisfaction while reducing costs of cardiac valve replacement and repair.

S Aranki, D Rosborough, G Couper … (1997)

This study compares the quality of valve replacement and repair performed through minimally invasive incisions as compared to the standard operation for aortic and mitral valve replacement. With the advent of minimally invasive laparoscopic approaches to orthopedic surgery, urology, general surgery, and thoracic surgery, it now is apparent that standard cardiac valve operations can be performed through very small incisions with similar approaches. Eighty-four patients underwent minimally invasive aortic (n = 41) and minimally invasive mitral valve repair and replacement (n = 43) between July 1996 and April 1997. Demographics, procedures, operative techniques, and postoperative morbidity and mortality were calculated, and a subset of the first 50 patients was compared to a 50-patient cohort who underwent the same operation through a conventional median sternotomy. Demographics, postoperative morbidity and mortality, patient satisfaction, and charges were compared. Of the 84 patients, there were 2 operative mortalities both in class IV aortic patients from multisystem organ failure. There was no operative mortality in the patients undergoing mitral valve replacement or repair. The operations were carried out with the same accuracy and attention to detail as with the conventional operation. There was minimal postoperative bleeding, cerebral vascular accidents, or other major morbidity. Groin cannulation complications primarily were related to atherosclerotic femoral arteries. A comparison of the minimally invasive to the conventional group, although operative time and ischemia time was higher in minimally invasive group, the requirement for erythrocytes was significantly less, patient satisfaction was significantly greater, and charges were approximately 20% less than those in the conventional group. Minimally invasive aortic and mitral valve surgery in patients without coronary disease can be done safely and accurately through small incisions. Patient satisfaction is up, return to normality is higher, and requirement for postrehabilitation services is less. In addition, the charges are approximately 20% less. These results serve as a paradigm for the future in terms of valve surgery in the managed care environment.

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Minimally invasive versus open mitral valve surgery: a consensus statement of the international society of minimally invasive coronary surgery (ISMICS) 2010.

Rachel L. Nifong, Frances J D Smith, Ehud Raanani … (2011)

: The purpose of this consensus conference was to deliberate the evidence regarding whether minimally invasive mitral valve surgery via thoracotomy improves clinical and resource outcomes compared with conventional open mitral valve surgery via median sternotomy in adults who require surgical intervention for mitral valve disease. : Before the consensus conference, the consensus panel reviewed the best available evidence up to March 2010, whereby systematic reviews, randomized trials, and nonrandomized trials were considered in descending order of validity and importance. The accompanying meta-analysis article in this issue of the Journal provides the systematic review of the evidence. Based on this systematic review, evidence-based statements were created for prespecified clinical questions, and consensus processes were used to derive recommendations. The American Heart Association/American College of Cardiology system was used to label the level of evidence and class of each recommendation. : Considering the underlying level of evidence, and notwithstanding the limitations of the evidence base (retrospective studies with important differences in baseline patient characteristics, which may produce bias in results of the evidence syntheses), the consensus panel provided the following evidence-based statements and overall recommendation:In patients with mitral valve disease, minimally invasive surgery may be an alternative to conventional mitral valve surgery (Class IIb), given that there was comparable short-term and long-term mortality (level B), comparable in-hospital morbidity (renal, pulmonary, cardiac complications, pain perception, and readmissions) (level B), reduced sternal complications, transfusions, postoperative atrial fibrillation, duration of ventilation, and intensive care unit and hospital length of stay (level B). However, this should be considered against the increased risk of stroke (2.1% vs 1.2%) (level B), aortic dissection (0.2% vs 0%) (level B), phrenic nerve palsy (3% vs 0%) (level B), groin infections/complications (2% vs 0%) (level B), and, prolonged cross-clamp time, cardiopulmonary bypass time, and procedure time (level B). The available evidence consists almost entirely of observational studies and must not be considered definitive until future adequately controlled randomized trials further address the risk of stroke, aortic complications, phrenic nerve complications, pain, long-term survival, need for reintervention, quality of life, and cost-effectiveness.

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Minimally invasive versus conventional mitral valve surgery: a propensity-matched comparison.

Lars G Svensson, Fernando A. Atik, Delos Cosgrove … (2010)

Less invasive approaches to mitral valve surgery are increasingly used for improved cosmesis; however, few studies have investigated their effect on outcome. We sought to compare these minimally invasive approaches fairly with conventional full sternotomy by using propensity-matching methods. From January 1995 to January 2004, 2124 patients underwent isolated mitral valve surgery through a minimally invasive approach, and 1047 underwent isolated mitral valve surgery through a conventional sternotomy. Because there were important differences in patient characteristics, a propensity score based on 42 factors was used to obtain 590 well-matched patient pairs (56% of cases). In-hospital mortality was similar for propensity-matched patients: 0.17% (1/590) for those undergoing minimally invasive surgery and 0.85% (5/590) for those undergoing conventional surgery (P = .2). Occurrences of stroke (P = .8), renal failure (P > .9), myocardial infarction (P = .7), and infection (P = .8) were also similar. However, 24-hour mediastinal drainage was less after minimally invasive surgery (median, 250 vs 350 mL; P < .0001), and fewer patients received transfusions (30% vs 37%, P = .01). More patients undergoing minimally invasive surgery were extubated in the operating room (18% vs 5.7%, P < .0001), and postoperative forced expiratory volume in 1 second was higher. Early after operation, pain scores were lower (P < .0001) after minimally invasive surgery. Within that portion of the spectrum of mitral valve surgery in which propensity matching was possible, minimally invasive mitral valve surgery had cosmetic, blood product use, respiratory, and pain advantages over conventional surgery, and no apparent detriments. Mortality and morbidity for robotic and percutaneous procedures should be compared with these minimally invasive outcomes. Copyright 2010. Published by Mosby, Inc.

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Author and article information

Journal

Journal ID (nlm-ta): Innovations (Phila)

Journal ID (iso-abbrev): Innovations (Phila)

Journal ID (publisher-id): ITT

Title: Innovations (Philadelphia, Pa.)

Publisher: Lippincott Williams & Wilkins

ISSN (Print): 1556-9845

ISSN (Electronic): 1559-0879

Publication date (Print): July 2016

Publication date (Electronic): 20 September 2016

Volume: 11

Issue: 4

Pages: 251-259

Affiliations

[1]From the *Northeast Georgia Physicians Group, Gainesville, GA USA; †Northwestern University, Feinberg School of Medicine, Chicago, IL USA; ‡Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN USA; §East Bay Cardiac Surgery Center, Oakland, CA USA; ∥Penn Presbyterian Medical Center, Philadelphia, PA USA; ¶The Toledo Hospital, Toledo, OH USA; #The Heart Hospital Baylor Plano, Plano, TX USA; **University of Virginia, Charlottesville, VA USA; ††Saint Elizabeth's Medical Center, Brighton, MA USA; ‡‡Gulf Coast Cardiothoracic & Vascular Surgeons, Ft. Myers, FL USA; §§Holy Spirit Northside Hospital, Chermside, Australia; ∥∥New York University School of Medicine, New York, NY USA; ¶¶Temple University, Philadelphia, PA USA; ##Swedish Heart and Vascular Institute, Seattle, WA USA; ***Penrose St. Francis Hospital, Colorado Springs, CO USA; †††Emory St. Joseph's Hospital, Atlanta, GA USA; ‡‡‡St. Thomas Hospital, Nashville, TN USA; §§§Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY USA; ∥∥∥South Florida Heart & Lung Institute, Doral, FL USA; ¶¶¶David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA USA; ###TriHealth Heart Institute, Cincinnati, OH USA; ****Central Maine Heart and Vascular Institute, Lewiston, ME USA; ††††Department of Cardiothoracic Surgery, Princeton Baptist Hospital, Birmingham, AL USA; and ‡‡‡‡Lankenau Medical Center, Wynnewood, PA USA.

Author notes

Address correspondence and reprint requests to Scott M. Goldman, MD, Lankenau Hospital, 280 Lankenau MSB, 100 Lancaster Ave, Wynnewood, PA 19096 USA. E-mail: GoldmanS@ 123456mlhs.org .

Article

Publisher ID: ITT50157 Accession ID: 00004

DOI: 10.1097/IMI.0000000000000300

PMC ID: 5051532

PubMed ID: 27654406

SO-VID: d1794baf-4a55-4035-89a7-9b6e0d695d56

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.

History

Date accepted : 16 June 2016

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Pages: 0

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Keywords: minimally invasive surgery (includes port access, minithoracotomy),mitral valve, repair, replacement,surgery/incisions/exposure/techniques,mvr, mimvr,heart valve,thoracotomy,endoscopic,lower hemisternotomy

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Keywords: minimally invasive surgery (includes port access, minithoracotomy), mitral valve, repair, replacement, surgery/incisions/exposure/techniques, mvr, mimvr, heart valve, thoracotomy, endoscopic, lower hemisternotomy

Minimally Invasive Mitral Valve Surgery II : Surgical Technique and Postoperative Management

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SICOT-J (Orthopedic surgery and traumatology)

Most cited references 15

Minimally invasive cardiac valve surgery improves patient satisfaction while reducing costs of cardiac valve replacement and repair.

Minimally invasive versus open mitral valve surgery: a consensus statement of the international society of minimally invasive coronary surgery (ISMICS) 2010.

Minimally invasive versus conventional mitral valve surgery: a propensity-matched comparison.

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