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Videoassisted And Sternotomy Approach For Otherwise Unaccessable Mitral Valve Surgery A Combination Of Both Strategies
Marie-Elisabeth Stelzmüller1, Günther Laufer2, Wilfried Wisser2.
1Medical University Vienna, vienna, Austria, 2Medical University Vienna, Vienna, Austria.

Objective: Minimal invasive surgery is our standard approach for mitral valve and for tricuspid valve surgery. Nevertheless there a few anatomic burdens, like deep thoracic cavity or long distance between chestwall and mitral valve, which impede the minimal invasive approach and a conventional sternotomy would be preferred. We report a case in which both videoendoscopic techniques as well as sternotomy approach was necessary to overcome the unfavourable anatomical situation. Methods: One male patient, 68years, 196cm tall, weight 99kg with severe mitral valve insufficiency, was sheduled for minimal invasive miral valve repair. Right sided mini-thoracotomy was performed. Videoendoscopic assisted exposure of the mitral ring was insufficient, therefore conversion to conventional surgery. We could expose the posterior annulus trough the transseptal approach directly, but need to use the videoendoscopic approach to visualize the anterior annulus. In this approach we performed a mechanical mitral valve replacement. Results: The postoperative echo showed an excellent positioning of the valve with no paravalvular insufficiency. The patient was extubated within the first postoperative day and was transferred to the general ward on day four POD. Nine days after the operation the patient developed a lymphatic fistula, with the need of surgical revision. Four days later the patients was discharged to home, without any further complications. Conclusion: In rare cases of extremely deep bevelled chests it can be impossible to visualize the mitral valve through a minimal invasive or sternotomy approach, respectively.

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