OBJECTIVE: To critically evaluate an initial experience with small-incision mitral valve operation with respect to safety, durability, and effectiveness. SUMMARY BACKGROUND DATA: Mitral valve (MV) surgery is dominated by a sternotomy approach, with MV repair rates which average 60%. Advantages of valvular repair compared with replacement include lower operative and long-term mortality, decreased stroke and infection risks, and superior freedom from reoperation and complications of anticoagulation. METHODS: Right chest small-incision MV surgery was performed on 187 consecutive patients. Outcomes including operative mortality and major morbidity were recorded. All patients underwent predismissal echocardiography in a core laboratory. RESULTS: Between 2003 and 2008, 57% (187/327) of isolated MV operations were performed using an anterolateral 6 cm 4th intercostal space small-incision. Operative techniques included femoral arterial and venous plus internal jugular cannulation and direct aortic cross-clamping. Pathology of the anterior leaflet was present in 22%, and PTFE neochordal repairs were used in 36% of cases. The rate of MV repair was 96.3% (180/187) and was 100% for patients with degenerative disease. Median cardiopulmonary bypass and aortic cross-clamp times were 108 and 82 minutes, respectively. There were no deaths, strokes, renal failure, or wound infections. Two patients (1.1%) were re-explored for bleeding, and 27% received blood transfusions. The median hospital stay was 4 days. Clinical core laboratory-assessed freedom from significant (MR > mild) at hospital discharge was 99%. Survival at a median follow-up of 2.5 years was 99%. CONCLUSIONS: Direct visualization of the mitral valve through a right chest small-incision enables safe and effective performance of complex MV repair, with repair rates in excess of 95%.
OBJECTIVE: To critically evaluate an initial experience with small-incision mitral valve operation with respect to safety, durability, and effectiveness. SUMMARY BACKGROUND DATA: Mitral valve (MV) surgery is dominated by a sternotomy approach, with MV repair rates which average 60%. Advantages of valvular repair compared with replacement include lower operative and long-term mortality, decreased stroke and infection risks, and superior freedom from reoperation and complications of anticoagulation. METHODS: Right chest small-incision MV surgery was performed on 187 consecutive patients. Outcomes including operative mortality and major morbidity were recorded. All patients underwent predismissal echocardiography in a core laboratory. RESULTS: Between 2003 and 2008, 57% (187/327) of isolated MV operations were performed using an anterolateral 6 cm 4th intercostal space small-incision. Operative techniques included femoral arterial and venous plus internal jugular cannulation and direct aortic cross-clamping. Pathology of the anterior leaflet was present in 22%, and PTFE neochordal repairs were used in 36% of cases. The rate of MV repair was 96.3% (180/187) and was 100% for patients with degenerative disease. Median cardiopulmonary bypass and aortic cross-clamp times were 108 and 82 minutes, respectively. There were no deaths, strokes, renal failure, or wound infections. Two patients (1.1%) were re-explored for bleeding, and 27% received blood transfusions. The median hospital stay was 4 days. Clinical core laboratory-assessed freedom from significant (MR > mild) at hospital discharge was 99%. Survival at a median follow-up of 2.5 years was 99%. CONCLUSIONS: Direct visualization of the mitral valve through a right chest small-incision enables safe and effective performance of complex MV repair, with repair rates in excess of 95%.
Authors: Rakesh M Suri; Vinod H Thourani; Brian R Englum; J Scott Rankin; Vinay Badhwar; Lars G Svensson; Gorav Ailawadi; Michael J Mack; Max He; J Matthew Brennan; Hartzell V Schaff; James S Gammie Journal: Ann Thorac Surg Date: 2014-03-27 Impact factor: 4.330
Authors: Alexander Iribarne; Rachel Easterwood; Mark J Russo; Y Claire Wang; Jonathan Yang; Kimberly N Hong; Craig R Smith; Michael Argenziano Journal: J Thorac Cardiovasc Surg Date: 2011-06-14 Impact factor: 5.209
Authors: Andrew B Goldstone; Pavan Atluri; Wilson Y Szeto; Alen Trubelja; Jessica L Howard; John W MacArthur; Craig Newcomb; Joseph P Donnelly; Dale M Kobrin; Mary A Sheridan; Christiana Powers; Robert C Gorman; Joseph H Gorman; Alberto Pochettino; Joseph E Bavaria; Michael A Acker; W Clark Hargrove; Y Joseph Woo Journal: J Thorac Cardiovasc Surg Date: 2013-03 Impact factor: 5.209
Authors: Alexander Iribarne; Rachel Easterwood; Edward Y H Chan; Jonathan Yang; Lori Soni; Mark J Russo; Craig R Smith; Michael Argenziano Journal: Future Cardiol Date: 2011-05