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Minimally Invasive Mitral Valve Repair: Results of the First 150 Cases Performed in an Australian Institution
252
Heart, Lung and Circulation 2011;20:250–284
ASCTS 2010 Abstracts
ABSTRACTS
discharge. Discussion: Even in this contemporary study, ‘the gap’ between Indigenous and non-Indigenous patient populations is evident. Younger patients with higher rates of preventable risk factors appear to constitute the Indigenous population. The burden of RHD in the Indigenous population is also evident. Despite often more advanced disease, Indigenous patients’ short term outcomes do not differ significantly from non-Indigenous patients. These results stress the importance of programs targeting risk factor modification and the prevention of RHD in the Indigenous population. Further long term follow-up is essential.
References [1] Australian Bureau of Statistics and Australian Institute of Health and Welfare. The health and welfare of Aboriginal and Torres Strai Islander peoples 2008. Canberra: ABS and AIHW; 2008 [ABS Cat. No. 4704.0; AIHW Cat. No. IHW 21]. [2] Lehman SJ, Baker RA, Aylward PE, Knight JL, Chew DP. Outcomes of cardiac surgery in Indigenous Australians. Med J Aust 2009;190:588–93.
doi:10.1016/j.hlc.2010.11.010 Minimally Invasive Mitral Valve Repair: Results of the First 150 Cases Performed in an Australian Institution E.K. Slimani ∗ , A. Venkataraman, T. Kitamura, J. Edwards Department of Cardiothoracic Surgery, Royal Adelaide Hospital Adelaide, South Australia, Australia Introduction: The traditional approach to the mitral valve has been through a median sternotomy. Significant advances in surgical techniques and instrumentation as well as perfusion technology has permitted mitral surgery to be performed using minimally invasive approaches. Due to reports of excellent clinical results minimally invasive mitral valve surgery has become a standard of care at many specialised centres worldwide. The purpose of this study was to examine the results of the initial 150 cases performed at our institution. Methods: Between July 2006 through to August 2010, 200 patients underwent minimally invasive surgery at the Royal Adelaide Hospital and Wakefield Hospital by a single surgeon. Of the 175 first time mitral valve procedures, 150 patients or 84.2% underwent a mitral valve repair through a right minithoracotomy utilising femoral cannulation and the Chitwood aortic cross clamp with antegrade cardioplegia. The mean age was 62.4 ± 13.4 years, and 65.3% were male. Myxomatous mitral valve regurgitation was present in 141 patients (94%), healed endocarditis in six patients (4%), and ischaemic mitral regurgitation in three patients (2%). Isolated mitral valve repair was performed in 125 patients (83.3%). Concurrent procedures performed with mitral valve repair included cryoablation left atrial Maze procedure (n = 16, 10.7%), closure of patent foramen ovale (n = 7, 4.7%), and closure of atrial septal defect (n = 2, 1.3%).
Results: Single leaflet repair was performed in 64% (posterior leaflet 56.6%, and anterior leaflet 7.4%) and two leaflet repair in 36%. The method used to achieve mitral valve repair was creation of Gortex neo-chordae in 130 patients (86.7%) quadrangular resection in nine patients (6%), combination of quadrangular resection and neo-chordae in five (3.3%), isolated annuloplasty ring in 4 (2.7%), and commisural closure in 2 (1.3%). An annuloplasty ring was used as part of the repair in 147 patients (98%). The mean aortic cross clamp and cardiopulmonary bypass times were 83.6 ± 28.5 min and 129.5 ± 37 min, respectively. A second period of cardioplegic arrest and aortic cross clamping was require to achieve a competent repair in two patients (1.3%) and mitral valve replacement was required in a further two patients (1.3%). Conversion to sternotomy was necessary in two patients due to an inability to perform peripheral cannulation to establish cardiopulmonary bypass. The 30 day mortality was 0.7% (n = 1). Complications included stroke in seven patients (4.6%), and reoperation for bleeding in six patients (4%). The mean intubation and intensive care unit admission times were nine hours and 48 hours respectively. The mean hospital length of stay was seven days. Echocardiography performed prior to discharge revealed no MR in 107 patients (71.3%), mild MR in 37 (24.7%), moderate MR in five (3.3%), and severe MR in one (0.7%) Conclusions: Minimally invasive mitral valve repair can be successfully introduced into an Australian institution and be performed with minimal morbidity and mortality. This approach may be the preferred technique for patients who require mitral valve repair. doi:10.1016/j.hlc.2010.11.011 Endoscopic Vein Harvesting—Is There a Role in Public Hospitals? Paul Wiemers ∗ , Matthew Brandon, Chimezie Uchime, Rajiv Sharma, Robert Tam Department of Cardiothoracic Surgery, The Townsville Hospital, Queensland, Australia Introduction: Endoscopic saphenous vein harvesting (EVH) for coronary artery bypass grafting (CABG) has been demonstrated in the literature to be superior to the conventional open harvest technique in regards to reducing leg wound complications [1]. In recent times concerns have been raised over the possibility of increased rates of graft failure and adverse clinical outcomes in patients who have undergone EVH [2]. Although being performed widely in the private sector in Australia, EVH has been utilised infrequently in the public hospital setting. With this study we aimed to investigate the use of EVH in a public hospital setting with a view to confirming reduced rates of wound complications, investigating early clinical outcomes and perhaps better defining a role for this technique in the public hospital setting. Methods: We undertook a prospective cohort study including 86 consecutive patients who underwent coronary artery bypass grafting at our institution between
Heart, Lung and Circulation 2011;20:250–284
ASCTS 2010 Abstracts
ABSTRACTS
discharge. Discussion: Even in this contemporary study, ‘the gap’ between Indigenous and non-Indigenous patient populations is evident. Younger patients with higher rates of preventable risk factors appear to constitute the Indigenous population. The burden of RHD in the Indigenous population is also evident. Despite often more advanced disease, Indigenous patients’ short term outcomes do not differ significantly from non-Indigenous patients. These results stress the importance of programs targeting risk factor modification and the prevention of RHD in the Indigenous population. Further long term follow-up is essential.
References [1] Australian Bureau of Statistics and Australian Institute of Health and Welfare. The health and welfare of Aboriginal and Torres Strai Islander peoples 2008. Canberra: ABS and AIHW; 2008 [ABS Cat. No. 4704.0; AIHW Cat. No. IHW 21]. [2] Lehman SJ, Baker RA, Aylward PE, Knight JL, Chew DP. Outcomes of cardiac surgery in Indigenous Australians. Med J Aust 2009;190:588–93.
doi:10.1016/j.hlc.2010.11.010 Minimally Invasive Mitral Valve Repair: Results of the First 150 Cases Performed in an Australian Institution E.K. Slimani ∗ , A. Venkataraman, T. Kitamura, J. Edwards Department of Cardiothoracic Surgery, Royal Adelaide Hospital Adelaide, South Australia, Australia Introduction: The traditional approach to the mitral valve has been through a median sternotomy. Significant advances in surgical techniques and instrumentation as well as perfusion technology has permitted mitral surgery to be performed using minimally invasive approaches. Due to reports of excellent clinical results minimally invasive mitral valve surgery has become a standard of care at many specialised centres worldwide. The purpose of this study was to examine the results of the initial 150 cases performed at our institution. Methods: Between July 2006 through to August 2010, 200 patients underwent minimally invasive surgery at the Royal Adelaide Hospital and Wakefield Hospital by a single surgeon. Of the 175 first time mitral valve procedures, 150 patients or 84.2% underwent a mitral valve repair through a right minithoracotomy utilising femoral cannulation and the Chitwood aortic cross clamp with antegrade cardioplegia. The mean age was 62.4 ± 13.4 years, and 65.3% were male. Myxomatous mitral valve regurgitation was present in 141 patients (94%), healed endocarditis in six patients (4%), and ischaemic mitral regurgitation in three patients (2%). Isolated mitral valve repair was performed in 125 patients (83.3%). Concurrent procedures performed with mitral valve repair included cryoablation left atrial Maze procedure (n = 16, 10.7%), closure of patent foramen ovale (n = 7, 4.7%), and closure of atrial septal defect (n = 2, 1.3%).
Results: Single leaflet repair was performed in 64% (posterior leaflet 56.6%, and anterior leaflet 7.4%) and two leaflet repair in 36%. The method used to achieve mitral valve repair was creation of Gortex neo-chordae in 130 patients (86.7%) quadrangular resection in nine patients (6%), combination of quadrangular resection and neo-chordae in five (3.3%), isolated annuloplasty ring in 4 (2.7%), and commisural closure in 2 (1.3%). An annuloplasty ring was used as part of the repair in 147 patients (98%). The mean aortic cross clamp and cardiopulmonary bypass times were 83.6 ± 28.5 min and 129.5 ± 37 min, respectively. A second period of cardioplegic arrest and aortic cross clamping was require to achieve a competent repair in two patients (1.3%) and mitral valve replacement was required in a further two patients (1.3%). Conversion to sternotomy was necessary in two patients due to an inability to perform peripheral cannulation to establish cardiopulmonary bypass. The 30 day mortality was 0.7% (n = 1). Complications included stroke in seven patients (4.6%), and reoperation for bleeding in six patients (4%). The mean intubation and intensive care unit admission times were nine hours and 48 hours respectively. The mean hospital length of stay was seven days. Echocardiography performed prior to discharge revealed no MR in 107 patients (71.3%), mild MR in 37 (24.7%), moderate MR in five (3.3%), and severe MR in one (0.7%) Conclusions: Minimally invasive mitral valve repair can be successfully introduced into an Australian institution and be performed with minimal morbidity and mortality. This approach may be the preferred technique for patients who require mitral valve repair. doi:10.1016/j.hlc.2010.11.011 Endoscopic Vein Harvesting—Is There a Role in Public Hospitals? Paul Wiemers ∗ , Matthew Brandon, Chimezie Uchime, Rajiv Sharma, Robert Tam Department of Cardiothoracic Surgery, The Townsville Hospital, Queensland, Australia Introduction: Endoscopic saphenous vein harvesting (EVH) for coronary artery bypass grafting (CABG) has been demonstrated in the literature to be superior to the conventional open harvest technique in regards to reducing leg wound complications [1]. In recent times concerns have been raised over the possibility of increased rates of graft failure and adverse clinical outcomes in patients who have undergone EVH [2]. Although being performed widely in the private sector in Australia, EVH has been utilised infrequently in the public hospital setting. With this study we aimed to investigate the use of EVH in a public hospital setting with a view to confirming reduced rates of wound complications, investigating early clinical outcomes and perhaps better defining a role for this technique in the public hospital setting. Methods: We undertook a prospective cohort study including 86 consecutive patients who underwent coronary artery bypass grafting at our institution between