hvsa
Home
Courses
Course Objectives
Programs
CME Credits
Cases and Abstract Submissions
venue and accomodations
HVSA
Directors and Faculty
Videos
Register

 

New York City Conference

Back to 2014 Annual Meeting Abstracts


Degenerative Mitral Valve Disease: Does Mini-thoracotomy Allow The Same Surgical Repair?
Marco Diena, Gheorghe Cerin, Bogdan Adrian Popa, Eugenio Novelli, Silvia Simonini, Angelo Romano, Levan Karazanishvili, Gabriele Musica.
San Gaudenzio Clinic, Novara, Italy.

OBJECTIVE: The key hole surgery is considered more cumbersome compared to sternotomy. We compared two groups of patients affected by degenerative mitral regurgitation in which the surgical repair was achieved through median sternotomy (Group 1) or right mini-thoracotomy (Group 2). We analysed the repairs from a technical point of view in order to verify whether a significant differences exist between the two approaches.
METHODS: Data from 585 patients who underwent mitral valve surgery from Jan'09 to Dec'13 were prospectively collected and analysed. For patients' characteristics see table 1. Surgery: within the minimally invasive approach the cardiopulmonary bypass was achieved through direct ascending aorta cannulation and insertion of a percutaneous venous cannula in the groin. A flexible aortic cross clamp was applied through the skin incision and cardioplegic arrest was obtained with delivery of antegrade Custodiol® HTK solution. The surgical strategy aimed to correct the MR with a single orifice and to rebuild the ToC using Gore-Tex chordae and annuloplasty. AML et lesion was addressed by reconstruction with polytetrafluoroethylene sutures. PML prolaps corrected by either quadrangular or triangular resection and/or neochordal implantation. An annuloplasty ring was implanted for each patient. Statistical analysis: in order to control the effect of possible confounding variables, a bivariate logistic regression using the propensity score of the surgical approach as regressor. RESULTS: There were similar rates of leaflet resection, implantation of PTFE neo-chordae and use of annuloplasty rings within the study groups. For details see table1.

GroupNr.MaleAgeLVEFLeaflet resectionQuadr. resectionTriang. resectionG-tex AMLG-tex PMLG-tex BOTHAnnuloplasty ringComplete ringIncomplete ring/other
1 (S)385203(52.7)65.7 ±1456.5±10125(32,4)48(12,4)77(20)28(7,2)139(36,4)172(44,6)382(99,2)341(88,6)41(10,6)
2 (M)200138(69.1)55.7 ±1261.6±6107(54,1)21(10,5)86(43)11(5,5)100(50)81(40,5)200(100)195(98,7)5(1,3)
p----0,17----0,10NS
Table . Patient's characteristics and surgical techniques. S= sternotomy. M= mini-thoracotomy CONCLUSIONS: In our experience, minimally invasive MV repair for degenerative incompetence allows a complete repair even in complex cases. No significant differences could be demonstrated between the two approaches. We may conclude that in right mini-thoracotomy allows the same surgical repair with good clinical and echocardiographic outcome.
Back to 2014 Annual Meeting Abstracts

     

Home | Courses | Objectives | Program | CME Credit | Cases & Abstracts | Venu & Accomodations | HVSA | Committee & Faculty | Register | Privacy Policy