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Different Approaches in Surgical Treatment of Mitral Valve Dysplasia


  • #AC/MIN 01-O-8
  • Adult Cardiac Surgery/Minimally Invasive and Robotic Cardiac Surgery. SESSION-1
  • Oral

Different Approaches in Surgical Treatment of Mitral Valve Dysplasia

Dmitry Kozmin, Igor Chernov, Soslan Enginoev, Sergey Makeev, Dmitry Kondratyev, Gasan Magomedov, Dmitry Tarasov

Federal Centre for Cardiovascular Surgery (Astrakhan), Astrakhan, Russia

Date, time and location: 2018.05.27 10:30, Congress Hall, 2F–C

Abstract

Objective: compare results of surgical treatment of degenerative mitral valve disease using right minithoracotomy vs conventional sternotomy.

Methods: This study includes a total 207 pts with surgery of myxomatous mitral valve in the period of 2009-2015 (mean age: 53.8±8.7 years; 107 males (52%); LVEF (60±5%), NYHA Class III-IV -126 (61%), atrial fibrillation -77 (37%), anterior leaflet prolapse -39 (18.8%), posterior leaflet prolapse -108 (52%), dual leaflet prolapse -60 (29%). Performed surgical treatment consisted of mitral repair 157 (75.9%); mitral valve replacement - 50 (24%), 22 (44%) had got a bioprosthesis; tricuspid interventions 54 (26%), RFAblation 15 (7%). Minimally invasive approach was used in 90 (group 1), sternotomy in 117 (group 2). Comparative analysis included cardiopulmonary bypass time (CPB), cross-clamp time (CCT), mechanical ventilation time (MVT), length of in-hospital and intensive care stay (HT, ICUT), volume of drain blood loss (VDBL), main complications (stroke, delirium, wound infection, lymphorrhea, pericarditis, tamponade) and mortality rate.

Results. Pts from group 1 had longer CPB (122 (98; 140) min Vs 98 (77; 118) min, p=0.001) and shorter MVT (10; (8-11) h Vs 11; (9-15) h, р =0.05), but CCT was equal in both groups (77 (65; 97) min and 73 (60; 93) min in group 1 and 2, retrospectively, р=0.1). ICUT was shorter in group 1 (20 (18; 26) h Vs 24 (20; 48), р=0.025). Pts from group 1 had smaller VDBL (200 (150; 350) ml Vs 300 (225; 525) ml, р=0.001), less pericardial punctures due to postoperative pericarditis (3 (3.3%) Vs 15 (12.8%), p=0.05). The rate of other complications equal in both groups. Studied groups didn’t have significant differences in HT (12 (10; 13) days Vs 13 (10; 15) days, р>0.1) and mortality rate (2 (2.2%) Vs 0 (0%), p=0.1).

Conclusion: Minimally invasive approach in addition to cosmetic results has other advantages: decrease ICUT, MVT, VDBL, pericarditis rate.


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