Why the study?
Minimally invasive mitral valve surgery without aortic cross-clamp had shown promising results in secondary mitral regurgitation with low ejection fraction or previous heart surgery, prompting reporting of center experience.
Is minimally invasive mitral valve surgery without aortic cross-clamp safe and effective in high-risk patients with secondary mitral regurgitation?
Is minimally invasive mitral valve surgery without aortic cross-clamp safe and effective in high-risk patients with secondary mitral regurgitation?
Minimally invasive mitral valve surgery without aortic cross-clamp is a feasible and safe strategy for high-risk patients with secondary mitral regurgitation, avoiding sternotomy and preserving cardiac function.
MIMVS-WAC may be feasible in high-risk secondary MR; leaves open need for prospective trials versus conventional approaches.
BACKGROUND: In patients with secondary mitral regurgitation (MR) associated with low ejection fraction or previous heart surgery, minimally invasive mitral valve surgery without aortic cross-clamp (MIMVS-WAC) has shown promising results. We report our experience for this strategy in our centers. METHODS: Between August 2011 and April 2017, 46 patients (mean age 69 ± 11 years, 76% males) received MIMVS-WAC. Indications for this technique were prior coronary bypass surgery (26%), severe or recent left ventricular (LV) dysfunction (30%), or both (39%). The mean EuroSCORE II was 12 ± 10. RESULTS: For each procedure, we conducted right minithoracotomy and hypothermic cardiopulmonary bypass (CPB) after peripheral cannulation. Mean CPB time was 159 ± 39 minutes. A mitral valve replacement (MVR) was performed in 23 cases (50%), an annuloplasty in 22 cases (48%), and a prosthesis pannus removal in 1 case (2%). Mean hospital length of stay was 12 ± 5.4 days. We report no sternotomy conversions, six reoperations for bleeding, and three deaths at 30 days. Transfusion was requested in 62% (mean infusion 2 ± 2.4 packed red blood cells). The postoperative echocardiography showed an LV function preservation in 69% of cases and a reduction of pulmonary arterial pressure in 73% of cases. Four additional deaths occurred in the long-term follow-up (mean 637 ± 381 days, median 593 days). No mitral reoperation was required, with a MR ≤ 2 in 90% of patients. CONCLUSION: In high-risk patients, the MIMVS-WAC is a safe technique. It avoids hard dissections while ensuring excellent preservation of cardiac function.
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Grinberg et al. (2019) studied this question.
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