Minimally Invasive Mitral Valve Repair on a Beating Heart through Minithoracotomy: an Alternative Approach in High Risk Patients
Lucía Pañeda Delgado, Barbara Segura Méndez, Eduardo Velasco García, Mireia Fernández Gutiérrez, Nuria Arce Ramos, Salvatore Di Stefano, Yolanda Carrascal Hinojal, Jose Ramón Echevarría Uribarri, Juan Bustamante Munguira
Hospital Clínico Universitario de Valladolid, Valladolid, Spain
Objective: Degenerative mitral regurgitation (MR) is the most common valve disease in developed countries. With the increase on life expectancy, patientsâ€™ profile aggravates due to comorbidities and old age, therefore surgical risk rockets. We should considerate lesser risk surgical procedures, given the unsuccessful outcomes of the percutaneous approach.
Methods: Applicability criteria: old age, severe degenerative MR due to isolated P2 prolapse in the absence of annulus dilatation nor calcification, and EuroSCORE II≥5. In the operating room, antero-lateral minithoracotomy through 5th intercostal space is performed to expose the left ventricleâ€™s apex. Two purse-string sutures are placed and, guided by transesophageal echocardiography, the device is directed towards P2. The prolapsing segment is captured and the chord implanted. Under the directions of the echocardiographer, the chord is pulled until MR disappears, then itâ€™s fixed to the apex. Postoperative care takes place applying ultra-fast-track protocol.
Results: Mean age was 85,6 years and mean Euroscore II was 7,1. Discharge took place on 4th postoperative day for most patients, without any complications during hospitalization or follow up. One case with borderline criteria (annulus lightly dilated and moderately calcificated) suffered left atrial perforation during the procedure; mitral valve replacement was performed urgently.
Conclusions: Minimally invasive mitral valve repair through off pump transapical chord implantation is a reproductible, safe surgical technique to take into consideration in elderly patients with MR due to P2 prolapse in the absence of annulus dilatation and calcification. Strict inclusion criteria must be applied in order to obtain good results.
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