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Barbero C, Pocar M, Brenna D, Parrella B, Baldarelli S, Aloi V, Costamagna A, Trompeo AC, Vairo A, Alunni G, Salizzoni S, Rinaldi M. Minimally Invasive Surgery: Standard of Care for Mitral Valve Endocarditis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1435. [PMID: 37629726 PMCID: PMC10456514 DOI: 10.3390/medicina59081435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023]
Abstract
Background. Minimally invasive surgery via right mini-thoracotomy has become the standard of care for the treatment of mitral valve disease worldwide, particularly at high-volume centers. In recent years, the spectrum of indications has progressively shifted and extended to fragile and higher-risk patients, also addressing more complex mitral valve disease and ultimately including patients with native or prosthetic infective endocarditis. The rationale for the adoption of the minimally invasive approach is to minimize surgical trauma, promote an earlier postoperative recovery, and reduce the incidence of surgical wound infection and other nosocomial infections. The aim of this retrospective observational study is to evaluate the effectiveness and the early and late outcome in patients undergoing minimally invasive surgery for mitral valve infective endocarditis. Methods. Prospectively collected data regarding minimally invasive surgery in patients with mitral valve infective endocarditis were entered into a dedicated database for the period between January 2007 and December 2022 and retrospectively analyzed. All comers during the study period underwent a preoperative evaluation based on their clinical history and anatomy for the allocation to the most appropriate surgical strategy. The selection of the mini-thoracotomy approach was primarily driven by a thorough transthoracic and especially transesophageal echocardiographic evaluation, coupled with total body and vascular imaging. Results. During the study period, 92 patients underwent right mini-thoracotomy to treat native (80/92, 87%) or prosthetic (12/92, 13%) mitral valve endocarditis at our institution, representing 5% of the patients undergoing minimally invasive mitral surgery. Twenty-six (28%) patients had undergone previous cardiac operations, whereas 18 (20%) presented preoperatively with complications related to endocarditis, most commonly systemic embolization. Sixty-nine and twenty-three patients, respectively, underwent early surgery (75%) or were operated on after the completion of the targeted antibiotic treatment (25%). A conservative procedure was feasible in 16/80 (20%) patients with native valve endocarditis. Conversion to standard sternotomy was necessary in a single case (1.1%). No cases of intraoperative iatrogenic aortic dissection were reported. Four patients died perioperatively, accounting for a thirty-day mortality of 4.4%. The causes of death were refractory heart or multiorgan failure and/or septic shock. A new onset stroke was observed postoperatively in one case (1.1%). Overall actuarial survival rate at 1 and 5 years after operation was 90.8% and 80.4%, whereas freedom from mitral valve reoperation at 1 and 5 years was 96.3% and 93.2%, respectively. Conclusions. This present study shows good early and long-term results in higher-risk patients undergoing minimally invasive surgery for mitral valve infective endocarditis. Total body, vascular, and echocardiographic screening represent the key points to select the optimal approach and allow for the extension of indications for minimally invasive surgery to sicker patients, including active endocarditis and sepsis.
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Affiliation(s)
- Cristina Barbero
- Division of Cardiac Surgery, Cardiovascular and Thoracic Department, “Città della Salute e della Scienza di Torino”, Molinette Hospital, Corso Dogliotti 14, 10126 Turin, Italy; (D.B.); (B.P.); (S.B.); (V.A.); (S.S.); (M.R.)
| | - Marco Pocar
- Division of Cardiac Surgery, Cardiovascular and Thoracic Department, “Città della Salute e della Scienza di Torino”, Molinette Hospital, Corso Dogliotti 14, 10126 Turin, Italy; (D.B.); (B.P.); (S.B.); (V.A.); (S.S.); (M.R.)
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy;
- Department of Clinical Sciences and Community Health (DISCCO), University of Milan, 20122 Milan, Italy
| | - Dario Brenna
- Division of Cardiac Surgery, Cardiovascular and Thoracic Department, “Città della Salute e della Scienza di Torino”, Molinette Hospital, Corso Dogliotti 14, 10126 Turin, Italy; (D.B.); (B.P.); (S.B.); (V.A.); (S.S.); (M.R.)
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy;
| | - Barbara Parrella
- Division of Cardiac Surgery, Cardiovascular and Thoracic Department, “Città della Salute e della Scienza di Torino”, Molinette Hospital, Corso Dogliotti 14, 10126 Turin, Italy; (D.B.); (B.P.); (S.B.); (V.A.); (S.S.); (M.R.)
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy;
| | - Sara Baldarelli
- Division of Cardiac Surgery, Cardiovascular and Thoracic Department, “Città della Salute e della Scienza di Torino”, Molinette Hospital, Corso Dogliotti 14, 10126 Turin, Italy; (D.B.); (B.P.); (S.B.); (V.A.); (S.S.); (M.R.)
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy;
| | - Valentina Aloi
- Division of Cardiac Surgery, Cardiovascular and Thoracic Department, “Città della Salute e della Scienza di Torino”, Molinette Hospital, Corso Dogliotti 14, 10126 Turin, Italy; (D.B.); (B.P.); (S.B.); (V.A.); (S.S.); (M.R.)
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy;
| | - Andrea Costamagna
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy;
- Division of Cardiac Intensive Care, Anesthesia, Intensive Care and Emergency Department, “Città della Salute e della Scienza di Torino”, Molinette Hospital, 10126 Turin, Italy;
| | - Anna Chiara Trompeo
- Division of Cardiac Intensive Care, Anesthesia, Intensive Care and Emergency Department, “Città della Salute e della Scienza di Torino”, Molinette Hospital, 10126 Turin, Italy;
| | - Alessandro Vairo
- Unit of Echocardiography, Division of Cardiology, Cardiovascular and Thoracic Department, “Città della Salute e della Scienza di Torino”, Molinette Hospital, 10126 Turin, Italy; (A.V.); (G.A.)
| | - Gianluca Alunni
- Unit of Echocardiography, Division of Cardiology, Cardiovascular and Thoracic Department, “Città della Salute e della Scienza di Torino”, Molinette Hospital, 10126 Turin, Italy; (A.V.); (G.A.)
| | - Stefano Salizzoni
- Division of Cardiac Surgery, Cardiovascular and Thoracic Department, “Città della Salute e della Scienza di Torino”, Molinette Hospital, Corso Dogliotti 14, 10126 Turin, Italy; (D.B.); (B.P.); (S.B.); (V.A.); (S.S.); (M.R.)
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy;
| | - Mauro Rinaldi
- Division of Cardiac Surgery, Cardiovascular and Thoracic Department, “Città della Salute e della Scienza di Torino”, Molinette Hospital, Corso Dogliotti 14, 10126 Turin, Italy; (D.B.); (B.P.); (S.B.); (V.A.); (S.S.); (M.R.)
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy;
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Claessens J, Rottiers R, Vandenbrande J, Gruyters I, Yilmaz A, Kaya A, Stessel B. Quality of life in patients undergoing minimally invasive cardiac surgery: a systematic review. Indian J Thorac Cardiovasc Surg 2023; 39:367-380. [PMID: 37346428 PMCID: PMC10279589 DOI: 10.1007/s12055-023-01501-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/03/2023] [Accepted: 03/07/2023] [Indexed: 04/05/2023] Open
Abstract
Objective Minimally invasive procedures have been developed to reduce surgical trauma after cardiac surgery. Clinical recovery is the main focus of most research. Still, patient-centred outcomes, such as the quality of life, can provide a more comprehensive understanding of the impact of the surgery on the patient's life. This systematic review aims to deliver a detailed summary of all available research investigating the quality of recovery, assessed with quality of life instruments, in adults undergoing minimally invasive cardiac surgery. Methods All randomised trials, cohort studies, and cross-sectional studies assessing the quality of recovery in patients undergoing minimally invasive cardiac surgery compared to conventional cardiac surgery within the last 20 years were included, and a summary was prepared. Results The randomised trial observed an overall improved quality of life after both minimally invasive and conventional surgery. The quality of life improvement in the minimally invasive group showed a faster course and evolved to a higher level than the conventional surgery group. These findings align with the results of prospective cohort studies. In the cross-sectional studies, no significant difference in the quality of life was seen except for one that observed a significantly higher quality of life in the minimally invasive group. Conclusions This systematic review indicates that patients may benefit from minimally invasive and conventional cardiac surgery, but patients undergoing minimally invasive cardiac surgery may recover sooner and to a greater extent. However, no firm conclusion could be drawn due to the limited available studies. Therefore, randomised controlled trials are needed.
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Affiliation(s)
- Jade Claessens
- Department of Cardiothoracic Surgery, Jessa Hospital, Stadsomvaart 11, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, LCRC, UHasselt - Hasselt University, Martelarenlaan 45, 3500 Hasselt, Belgium
| | - Roxanne Rottiers
- Faculty of Medicine and Life Sciences, LCRC, UHasselt - Hasselt University, Martelarenlaan 45, 3500 Hasselt, Belgium
- Department of Anesthesiology and Perioperative Medicine, Ghent University, Corneel Heymanslaan 10, Ghent, Belgium
| | - Jeroen Vandenbrande
- Department of Anaesthesiology and Pain Medicine, Jessa Hospital, Stadsomvaart 11, Hasselt, Belgium
| | - Ine Gruyters
- Department of Anaesthesiology and Pain Medicine, Jessa Hospital, Stadsomvaart 11, Hasselt, Belgium
| | - Alaaddin Yilmaz
- Department of Cardiothoracic Surgery, Jessa Hospital, Stadsomvaart 11, Hasselt, Belgium
| | - Abdullah Kaya
- Department of Cardiothoracic Surgery, Jessa Hospital, Stadsomvaart 11, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, LCRC, UHasselt - Hasselt University, Martelarenlaan 45, 3500 Hasselt, Belgium
| | - Björn Stessel
- Faculty of Medicine and Life Sciences, LCRC, UHasselt - Hasselt University, Martelarenlaan 45, 3500 Hasselt, Belgium
- Department of Anaesthesiology and Pain Medicine, Jessa Hospital, Stadsomvaart 11, Hasselt, Belgium
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Akowuah EF, Maier RH, Hancock HC, Kharatikoopaei E, Vale L, Fernandez-Garcia C, Ogundimu E, Wagnild J, Mathias A, Walmsley Z, Howe N, Kasim A, Graham R, Murphy GJ, Zacharias J. Minithoracotomy vs Conventional Sternotomy for Mitral Valve Repair: A Randomized Clinical Trial. JAMA 2023; 329:1957-1966. [PMID: 37314276 PMCID: PMC10265311 DOI: 10.1001/jama.2023.7800] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/23/2023] [Indexed: 06/15/2023]
Abstract
Importance The safety and effectiveness of mitral valve repair via thoracoscopically-guided minithoracotomy (minithoracotomy) compared with median sternotomy (sternotomy) in patients with degenerative mitral valve regurgitation is uncertain. Objective To compare the safety and effectiveness of minithoracotomy vs sternotomy mitral valve repair in a randomized trial. Design, Setting, and Participants A pragmatic, multicenter, superiority, randomized clinical trial in 10 tertiary care institutions in the UK. Participants were adults with degenerative mitral regurgitation undergoing mitral valve repair surgery. Interventions Participants were randomized 1:1 with concealed allocation to receive either minithoracotomy or sternotomy mitral valve repair performed by an expert surgeon. Main Outcomes and Measures The primary outcome was physical functioning and associated return to usual activities measured by change from baseline in the 36-Item Short Form Health Survey (SF-36) version 2 physical functioning scale 12 weeks after the index surgery, assessed by an independent researcher masked to the intervention. Secondary outcomes included recurrent mitral regurgitation grade, physical activity, and quality of life. The prespecified safety outcomes included death, repeat mitral valve surgery, or heart failure hospitalization up to 1 year. Results Between November 2016 and January 2021, 330 participants were randomized (mean age, 67 years, 100 female [30%]); 166 were allocated to minithoracotomy and 164 allocated to sternotomy, of whom 309 underwent surgery and 294 reported the primary outcome. At 12 weeks, the mean between-group difference in the change in the SF-36 physical function T score was 0.68 (95% CI, -1.89 to 3.26). Valve repair rates (≈ 96%) were similar in both groups. Echocardiography demonstrated mitral regurgitation severity as none or mild for 92% of participants at 1 year with no difference between groups. The composite safety outcome occurred in 5.4% (9 of 166) of patients undergoing minithoracotomy and 6.1% (10 of 163) undergoing sternotomy at 1 year. Conclusions and relevance Minithoracotomy is not superior to sternotomy in recovery of physical function at 12 weeks. Minithoracotomy achieves high rates and quality of valve repair and has similar safety outcomes at 1 year to sternotomy. The results provide evidence to inform shared decision-making and treatment guidelines. Trial Registration isrctn.org Identifier: ISRCTN13930454.
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Affiliation(s)
- Enoch F. Akowuah
- Department of Cardiac Surgery, the James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom
| | - Rebecca H. Maier
- Academic Cardiovascular Unit, the James Cook University Hospital, South Tees Hosptials NHS Foundation Trust, Middlesbrough, United Kingdom
| | - Helen C. Hancock
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | | | - Luke Vale
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | | | - Emmanuel Ogundimu
- Department of Mathematical Sciences, Durham University, Durham, United Kingdom
| | - Janelle Wagnild
- Department of Anthropology, Durham University, Durham, United Kingdom
| | - Ayesha Mathias
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Zoe Walmsley
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Nicola Howe
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Adetayo Kasim
- Department of Anthropology, Durham University, Durham, United Kingdom
- Now with GSK, United Kingdom
| | - Richard Graham
- Department of Cardiac Surgery, the James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, United Kingdom
| | - Gavin J. Murphy
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Unit in Cardiovascular Medicine, University of Leicester, Leicester, United Kingdom
| | - Joseph Zacharias
- The Lancashire Cardiac Center, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, United Kingdom
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Hussain S, Swystun AG, Caputo M, Angelini GD, Vohra HA. A review and meta-analysis of conventional sternotomy versus minimally invasive mitral valve surgery for degenerative mitral valve disease focused on the last decade of evidence. Perfusion 2023:2676591231174579. [PMID: 37145960 DOI: 10.1177/02676591231174579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
OBJECTIVES Early meta-analyses comparing minimally invasive mitral valve surgery (MIMVS) with conventional sternotomy (CS) have determined the safety of MIMVS. We performed this review and meta-analysis based on studies from 2014 onwards to examine the differences in outcomes between MIMVS and CS. Specifically, some outcomes of interest included renal failure, new onset atrial fibrillation, mortality, stroke, reoperation for bleeding, blood transfusion and pulmonary infection. METHODS A systematic search was performed in six databases for studies comparing MIMVS with CS. Although the initial search identified 821 papers in total, nine studies were suitable for the final analysis. All studies included compared CS with MIMVS. The Mantel - Haenszel statistical method was chosen due the use of inverse variance and random effects. A meta-analysis was performed on the data. RESULTS MIMVS had significantly lower odds of renal failure (OR: 0.52; 95% CI 0.37 to 0.73, p < 0.001), new onset atrial fibrillation (OR: 0.78; 95% CI 0.67 to 0.90, p < 0.001), reduced prolonged intubation (OR: 0.50; 95% CI 0.29 to 0.87, p = 0.01) and reduced mortality (OR: 0.58; 95% CI 0.38 to 0.87, p < 0.01). MIMVS had shorter ICU stay (WMD: -0.42; 95% CI -0.59 to -0.24, p < 0.001) and shorter time to discharge (WMD: -2.79; 95% CI -3.86 to -1.71, p < 0.001). CONCLUSION In the modern era, MIMVS for degenerative disease is associated with improved short-term outcomes when compared to the CS.
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Affiliation(s)
| | | | - Massimo Caputo
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol, UK
| | | | - Hunaid A Vohra
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol, UK
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Berretta P, De Angelis V, Alfonsi J, Pierri MD, Malvindi PG, Zahedi HM, Munch C, Di Eusanio M. Enhanced recovery after minimally invasive heart valve surgery: Early and midterm outcomes. Int J Cardiol 2023; 370:98-104. [PMID: 36375597 DOI: 10.1016/j.ijcard.2022.11.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/03/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Although the use of protocols for "enhanced recovery after surgery" (ERAS) have been associated with improved results in different surgical specialties, only a few data are available for ERAS in cardiac surgery. This study aimed to compare 30-day outcomes of patients undergoing ultra-fast-track minimally invasive valve surgery (UFT-MIVS) versus conventional MIVS (c-MIVS). METHODS The key features of UFT-MIVS approach involves: 1) less invasive valve surgery techniques, 2) normothermic cardiopulmonary bypass management, 3) UFT-anesthesia with table extubation, 4) immediate rehabilitation therapy and patient-family contact. Five-hundred and seventy-six consecutive patients who underwent aortic or mitral MIVS were analyzed (2016-2020). Treatment selection bias (UFT-MIVS vs. c-MIVS) was addressed by the use of propensity score (PS) matching. After PS-matching 2 well-balanced groups of 152 patients each were created. RESULTS In the matched cohort, the overall 30-day mortality and stroke rates were 0.3% and 0.7%, respectively, with no difference between groups. UFT-MIVS resulted in lower rates of respiratory insufficiency and agitation/delirium compared with c-MIVS. Patients receiving UFT-MIVS were associated with significantly shorter intensive care unit length of stay and hospital stay. CONCLUSIONS Our study confirms that MIVS is associated with excellent results in terms of early mortality and major postoperative complications rates. The implementation of UFT-MIVS protocol showed to be safe and was associated with improved clinical outcomes in regard to respiratory insufficiency, delirium and lengths of stay.
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Affiliation(s)
- Paolo Berretta
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Via Conca 71, 60126 Ancona, Italy.
| | - Veronica De Angelis
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Via Conca 71, 60126 Ancona, Italy
| | - Jacopo Alfonsi
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Via Conca 71, 60126 Ancona, Italy
| | - Michele D Pierri
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Via Conca 71, 60126 Ancona, Italy
| | - Pietro Giorgio Malvindi
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Via Conca 71, 60126 Ancona, Italy
| | - Hossein M Zahedi
- Cardiac Anaesthesia and Intensive Care Unit, Lancisi Cardiovascular Center, Via Conca 71, 60126 Ancona, Italy
| | - Christopher Munch
- Cardiac Anaesthesia and Intensive Care Unit, Lancisi Cardiovascular Center, Via Conca 71, 60126 Ancona, Italy
| | - Marco Di Eusanio
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Via Conca 71, 60126 Ancona, Italy
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Hashim SW, McMahon SR, Vaitkeviciute IK, Collazo S, Hashim IM, Loya DS, Takata ET, Mather JF, McKay RG. Propensity-matched comparison of right mini-thoracotomy versus median sternotomy for isolated mitral valve repair. THE JOURNAL OF CARDIOVASCULAR SURGERY 2022; 63:724-733. [PMID: 36106398 DOI: 10.23736/s0021-9509.22.12397-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND A right mini-thoracotomy (RT) versus median sternotomy (MS) approach for isolated mitral valve (MV) repair has been associated with less postoperative morbidity, shorter hospital stay, and faster functional recovery, but with consistently longer cross-clamp time and higher operative costs. METHODS We assessed the impact of a modified operative technique on outcomes in 158 RT versus 129 MS patients treated with myxomatous MV repair from 2016 through 2021. Propensity matching based upon the Society of Thoracic Surgeons Risk Score was used to compare 108 patients in each cohort. RESULTS Propensity-matched RT patients had reductions in total ventilation time (P=0.025), postoperative atrial fibrillation (P=0.019), and hospital length of stay (P<0.001). RT and MS patients had similar cross-clamp times (66.4±13.7 vs 64.8±16.0 minutes, P=0.414), with less overall leaflet resection (32.4% vs 57.4%, P<0.001) and fewer Gore-Tex NeoChords implanted per patient (1.7±0.7 vs 2.1±1.0, P=0.028) in the RT group. The two cohorts did not differ with respect to 30-day major surgical complications. No patient died and there was no difference between the two groups with respect to freedom from re-operation (98.2% vs 98.2%, P=0.800) at a mean follow-up of 21.4±18.5 months. Direct total hospital costs were lower for the RT group (P=0.018), with reductions in postoperative charges offsetting increased operating room costs. CONCLUSIONS In this single-center study, the RT compared to the MS approach for myxomatous MV repair resulted in less postoperative morbidity and shorter hospital length of stay, with similar cross-clamp time, reduced total hospital costs, and comparable intermediate outcomes.
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Affiliation(s)
- Sabet W Hashim
- Hartford Health Care Heart and Vascular Institute, Hartford Hospital, Hartford, CT, USA
| | - Sean R McMahon
- Hartford Health Care Heart and Vascular Institute, Hartford Hospital, Hartford, CT, USA
| | - Irena K Vaitkeviciute
- Hartford Health Care Heart and Vascular Institute, Hartford Hospital, Hartford, CT, USA
| | - Susan Collazo
- Hartford Health Care Heart and Vascular Institute, Hartford Hospital, Hartford, CT, USA
| | | | - Deborah S Loya
- Hartford Health Care Heart and Vascular Institute, Hartford Hospital, Hartford, CT, USA
| | - Edmund T Takata
- Integrated Anesthesia Associates, Hartford Hospital, Hartford, CT, USA -
| | - Jeff F Mather
- Research Administration, Hartford Hospital, Hartford, CT, USA
| | - Raymond G McKay
- Hartford Health Care Heart and Vascular Institute, Hartford Hospital, Hartford, CT, USA
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Strobel RJ, Hawkins RB, Mehaffey JH, Rotar EP, Yount KW, Teman NR, Ailawadi G. Minimally Invasive Approaches Are Safe for Concomitant Mitral and Tricuspid Valve Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2022; 17:416-423. [DOI: 10.1177/15569845221128297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: The need for concomitant tricuspid surgery during mitral valve surgery is associated with higher operative risk. We hypothesized that concomitant tricuspid surgery through a minimally invasive thoracotomy (MICS) is associated with noninferior risk compared with a sternotomy. Methods: All patients undergoing mitral valve surgery at a single institution (2010 to 2020) were evaluated. After excluding endocarditis, emergent operations, and concomitant aortic valve or coronary artery bypass grafting procedures, patients were stratified by MICS versus sternotomy. Multivariable logistic regression assessed the risk-adjusted association between concomitant tricuspid valve procedure and Society of Thoracic Surgeons major morbidity or mortality. An interaction term evaluated the impact of approach on concomitant tricuspid surgery. Results: A total of 772 patients underwent mitral valve surgery, including 138 (17.9%) with concomitant tricuspid valve operation. Of the total cohort, 243 patients (31.5%) underwent the MICS approach. Concomitant tricuspid operation was performed in 104 sternotomy patients (19.7%) compared with 34 MICS patients (14.0%, P = 0.056). After risk adjustment, patients who underwent concomitant tricuspid valve surgery via sternotomy had nearly 2 times greater odds of morbidity and mortality relative to those undergoing isolated mitral surgery via sternotomy (adjOR = 1.86, P = 0.049), while patients who underwent concomitant tricuspid surgery via the MICS approach had no increased risk of the composite outcome (adjOR = 0.66, P = 0.543), relative to isolated mitral surgery via MICS approach. Conclusions: Concomitant tricuspid surgery at the time of mitral valve surgery carries additional risk in a broad patient population. A minimally invasive approach appears to be safe for selected patients requiring concomitant tricuspid valve surgery.
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Affiliation(s)
- Raymond J. Strobel
- Division of Cardiac Surgery, University of Virginia, Charlottesville, VA, USA
| | - Robert B. Hawkins
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
| | - J. Hunter Mehaffey
- Division of Cardiac Surgery, University of Virginia, Charlottesville, VA, USA
| | - Evan P. Rotar
- Division of Cardiac Surgery, University of Virginia, Charlottesville, VA, USA
| | - Kenan W. Yount
- Division of Cardiac Surgery, University of Virginia, Charlottesville, VA, USA
| | - Nicholas R. Teman
- Division of Cardiac Surgery, University of Virginia, Charlottesville, VA, USA
| | - Gorav Ailawadi
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
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8
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Olsthoorn JR, Heuts S, Houterman S, Maessen JG, Sardari Nia P. Effect of minimally invasive mitral valve surgery compared to sternotomy on short- and long-term outcomes: a retrospective multicentre interventional cohort study based on Netherlands Heart Registration. Eur J Cardiothorac Surg 2021; 61:1099-1106. [PMID: 34878099 DOI: 10.1093/ejcts/ezab507] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/25/2021] [Accepted: 11/01/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Minimally invasive mitral valve surgery (MIMVS) has been performed increasingly for the past 2 decades; however, large comparative studies on short- and long-term outcomes have been lacking. This study aims to compare short- and long-term outcomes of patients undergoing MIMVS versus median sternotomy (MST) based on real-world data, extracted from the Netherlands Heart Registration. METHODS Patients undergoing mitral valve surgery, with or without tricuspid valve, atrial septal closure and/or rhythm surgery between 2013 and 2018 were included. Primary outcomes were short-term morbidity and mortality and long-term survival. Propensity score matching analyses were performed. RESULTS In total, 2501 patients were included, 1776 were operated through MST and 725 using an MIMVS approach. After propensity matching, no significant differences in baseline characteristics persisted. There were no between-group differences in 30-day mortality (1.1% vs 0.7%, P = 0.58), 1-year mortality (2.6% vs 2.1%, P = 0.60) or perioperative stroke rate (1.1% vs 0.6%, P = 0.25) between MST and MIMVS, respectively. An increased rate of postoperative arrhythmia was observed in the MST group (31.3% vs 22.4%, P < 0.001). A higher repair rate was found in the MST group (80.9% vs 76.3%, P = 0.04). No difference in 5-year survival was found between the matched groups (95.0% vs 94.3%, P = 0.49). Freedom from mitral reintervention was 97.9% for MST and 96.8% in the MIMVS group (P = 0.01), without a difference in reintervention-free survival (P = 0.30). CONCLUSIONS The MIMVS approach is as safe as the sternotomy approach for the surgical treatment of mitral valve disease. However, it comes at a cost of a reduced repair rate and more reinterventions in the long term, in the real-world.
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Affiliation(s)
- Jules R Olsthoorn
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, Netherlands.,Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, Eindhoven, Netherlands
| | - Samuel Heuts
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, Netherlands
| | | | - Jos G Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
| | - Peyman Sardari Nia
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
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9
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Maier RH, Kasim AS, Zacharias J, Vale L, Graham R, Walker A, Laskawski G, Deshpande R, Goodwin A, Kendall S, Murphy GJ, Zamvar V, Pessotto R, Lloyd C, Dalrymple-Hay M, Casula R, Vohra HA, Ciulli F, Caputo M, Stoica S, Baghai M, Niranjan G, Punjabi PP, Wendler O, Marsay L, Fernandez-Garcia C, Modi P, Kirmani BH, Pullan MD, Muir AD, Pousios D, Hancock HC, Akowuah E. Minimally invasive versus conventional sternotomy for Mitral valve repair: protocol for a multicentre randomised controlled trial (UK Mini Mitral). BMJ Open 2021; 11:e047676. [PMID: 33853807 PMCID: PMC8054102 DOI: 10.1136/bmjopen-2020-047676] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Numbers of patients undergoing mitral valve repair (MVr) surgery for severe mitral regurgitation have grown and will continue to rise. MVr is routinely performed via median sternotomy; however, there is a move towards less invasive surgical approaches.There is debate within the clinical and National Health Service (NHS) commissioning community about widespread adoption of minimally invasive MVr surgery in the absence of robust research evidence; implementation requires investment in staff and infrastructure.The UK Mini Mitral trial will provide definitive evidence comparing patient, NHS and clinical outcomes in adult patients undergoing MVr surgery. It will establish the best surgical approach for MVr, setting a standard against which emerging percutaneous techniques can be measured. Findings will inform optimisation of cost-effective practice. METHODS AND ANALYSIS UK Mini Mitral is a multicentre, expertise based randomised controlled trial of minimally invasive thoracoscopically guided right minithoracotomy versus conventional sternotomy for MVr. The trial is taking place in NHS cardiothoracic centres in the UK with established minimally invasive mitral valve surgery programmes. In each centre, consenting and eligible patients are randomised to receive surgery performed by consultant surgeons who meet protocol-defined surgical expertise criteria. Patients are followed for 1 year, and consent to longer term follow-up.Primary outcome is physical functioning 12 weeks following surgery, measured by change in Short Form Health Survey (SF-36v2) physical functioning scale. Early and 1 year echo data will be reported by a core laboratory. Estimates of key clinical and health economic outcomes will be reported up to 5 years.The primary economic outcome is cost effectiveness, measured as incremental cost per quality-adjusted life year gained over 52 weeks following index surgery. ETHICS AND DISSEMINATION A favourable opinion was given by Wales REC 6 (16/WA/0156). Trial findings will be disseminated to patients, clinicians, commissioning groups and through peer reviewed publication. TRIAL REGISTRATION NUMBER ISRCTN13930454.
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Affiliation(s)
- Rebecca H Maier
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | | | - Joseph Zacharias
- The Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Luke Vale
- Health Economics Group, Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Richard Graham
- Cardiothoracic Surgery, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Antony Walker
- The Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Grzegorz Laskawski
- The Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | - Ranjit Deshpande
- Cardiothoracic Surgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Andrew Goodwin
- Cardiothoracic Surgery, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Simon Kendall
- Cardiothoracic Surgery, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Gavin J Murphy
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Unit in Cardiovascular Medicine, University of Leicester, Leicester, UK
| | - Vipin Zamvar
- Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Renzo Pessotto
- Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Clinton Lloyd
- Cardiothoracic Surgery, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | | | - Roberto Casula
- Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Hunaid A Vohra
- Cardiothoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Franco Ciulli
- Cardiothoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Massimo Caputo
- Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Serban Stoica
- Cardiothoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Max Baghai
- Cardiothoracic Surgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Gunaratnam Niranjan
- Cardiac Surgery, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Prakash P Punjabi
- Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Olaf Wendler
- Cardiothoracic Surgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Leanne Marsay
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | | | - Paul Modi
- Cardiothoracic Surgery, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Bilal H Kirmani
- Cardiothoracic Surgery, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Mark D Pullan
- Cardiothoracic Surgery, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Andrew D Muir
- Cardiothoracic Surgery, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Dimitrios Pousios
- Cardiothoracic Surgery, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Helen C Hancock
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Enoch Akowuah
- Cardiothoracic Surgery, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
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10
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Abstract
There is considerable interest and demand in the application of minimally invasive techniques in cardiac surgery driven by multiple factors including patient cosmesis and satisfaction, reduction of surgical trauma and the development of specialized instrumentation that allows these procedures to be performed safely. Minimally invasive mitral valve surgery (MIMVS) has been conducted for more than 25 years and has been shown to offer multiple benefits including better cosmetic results, enhanced post-operative recovery, improved patient satisfaction and most importantly, equivalent clinical outcomes with regards to quality and safety when compared to the standard sternotomy approach. MIMVS may be particularly beneficial in certain subgroups of patients, for example patients undergoing redo mitral valve surgery. In this article, we discuss patient selection criteria for MIMVS, the merits and drawbacks of MIMVS relative to conventional sternotomy approaches, and detail procedural aspects including anaesthetic management, intraoperative technique, and important considerations in myocardial protection and cardiopulmonary bypass (CPB). When considering developing a MIMVS programme, as for any new technique, a team approach to the introduction of the programme is essential. Although it is clear that patient selection is important, particularly early in a surgical programme, with experience complex repairs can be performed through a minimally invasive approach with excellent outcomes.
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Affiliation(s)
- Yasir Abu-Omar
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Ibrahim T Fazmin
- Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, UK
| | - Jason M Ali
- Department of Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, UK
| | - Marc P Pelletier
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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11
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Barbero C, Marchetto G, Pace Napoleone C, Calia C, Cura Stura E, Pocar M, Rinaldi M, Boffini M. Right mini-thoracotomy approach for grown-up congenital heart disease. J Card Surg 2021; 36:1917-1921. [PMID: 33634523 DOI: 10.1111/jocs.15449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/05/2021] [Accepted: 02/11/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Right mini-thoracotomy cardiac surgery has been recognized as a safe and effective procedure, with remarkable early and long-terms outcomes. However, most of the literature is focused on mitral valve surgery and few studies report on the minimally invasive approach applied to congenital disease. Aim of this study was to review our experience on patients with grown-up congenital heart (GUCH) undergoing right mini-thoracotomy cardiac surgery. METHODS Data of patients with GUCH undergoing right mini-thoracotomy cardiac surgery from 2006 to 2019 were retrospectively analyzed. Inclusion criteria were atrial septal defect, partial anomalous pulmonary venous return, partial atrioventricular septal defect, and mitral or tricuspid valve dysfunction in congenital heart diseases. RESULTS During the study period 127 patients with GUCH underwent right mini-thoracotomy cardiac surgery. Mean age was 43.6 years and more than 60% were females; diagnosis was atrial septal defect in 57 cases (44.9%); 24 patients were redo (18.9%). No cases of stroke and major vascular complications were reported. Conversion to sternotomy was required in one case (0.8%). No residual shunts or valves dysfunction were recorded at the postoperative echocardiographic evaluation. Perioperative mortality was 1.6%. CONCLUSIONS Right mini-thoracotomy cardiac surgery in selected patients with GUCH allows to avoid the big scar of the sternotomy approach and to accelerate the recovery in a young population. Moreover, in redo cases, it allows the surgeon to reach the heart and the aorta avoiding the well-known risks of a re-sternotomy procedure.
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Affiliation(s)
- Cristina Barbero
- Department of Cardiovascular and Thoracic Surgery, Città della Salute e della Scienza, University of Turin, Torino, Italy
| | - Giovanni Marchetto
- Department of Cardiovascular and Thoracic Surgery, Città della Salute e della Scienza, University of Turin, Torino, Italy
| | - Carlo Pace Napoleone
- Pediatric Cardiac Surgery Division, Department of Pediatrics, Children's Regina Margherita Hospital, Torino, Italy
| | - Claudia Calia
- Department of Cardiovascular and Thoracic Surgery, Città della Salute e della Scienza, University of Turin, Torino, Italy
| | - Erik Cura Stura
- Department of Cardiovascular and Thoracic Surgery, Città della Salute e della Scienza, University of Turin, Torino, Italy
| | - Marco Pocar
- Department of Cardiovascular and Thoracic Surgery, Città della Salute e della Scienza, University of Turin, Torino, Italy
| | - Mauro Rinaldi
- Department of Cardiovascular and Thoracic Surgery, Città della Salute e della Scienza, University of Turin, Torino, Italy
| | - Massimo Boffini
- Department of Cardiovascular and Thoracic Surgery, Città della Salute e della Scienza, University of Turin, Torino, Italy
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12
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Perin G, Shaw M, Toolan C, Palmer K, Al-Rawi O, Modi P. Cost Analysis of Minimally Invasive Mitral Valve Surgery in the UK National Health Service. Ann Thorac Surg 2020; 112:124-131. [PMID: 33068544 DOI: 10.1016/j.athoracsur.2020.08.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/04/2020] [Accepted: 08/06/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND In the UK National Health Service, finite resources make the adoption of minimally invasive (MI) mitral valve surgery challenging unless greater operative costs (vs sternotomy [ST]) are balanced by postoperative savings. This study examined whether the cost analysis now became unfavorable. METHODS All patients (n = 380) undergoing isolated mitral valve surgery with or without a maze procedure over a 3-year period by either MI or ST approaches were included. Propensity matching (2 cohorts, 1:1 matched;, n = 75 per group) and multivariable regression were used to assess for the effect on cost. Cost data were prospectively collected from Service Line Reporting and reported in Sterling (£) as median (interquartile range [IQR]). RESULTS Matched data revealed that total hospital costs were equivalent (MI vs ST, £16,672 [IQR, £15,044, £20,611] vs £15,875 [IQR, £12,281, £20,687]; P .33). Three of 15 costing pools were significantly different: operative costs were higher for the MI group (MI vs ST, £7458 [IQR, £6738, £8286] vs £5596 iIQR, £4204, £6992]; P < .001), whereas ward costs (boarding, nursing) (MI vs ST, £1464 [IQR, £1146, £1864] vs £1733 [IQR, £1403, £2445] P = .006) and pharmacy services (MI vs ST, £187 [IQR, £140, £239] vs £244 [IQR, £179, £375] P < .001) were lower for the MI group. Hospital stay was shorter in the MI group (MI vs ST, 6 days [IQR, 5, 8 days] vs 8 days [IQR, 6, 11 days]; P < .001). Multivariable regression produced similar findings. CONCLUSIONS There was no difference in overall hospital cost between MI and ST mitral valve surgery: higher operative costs of MI surgery were offset by lower postoperative costs, with a 2-day shorter hospital stay.
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Affiliation(s)
- Giordano Perin
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, NHS Foundation Trust, Liverpool, United Kingdom; Department of Cardiothoracic Anaesthesia, Liverpool Heart and Chest Hospital, NHS Foundation Trust, Liverpool, United Kingdom
| | - Matthew Shaw
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, NHS Foundation Trust, Liverpool, United Kingdom; Department of Cardiothoracic Anaesthesia, Liverpool Heart and Chest Hospital, NHS Foundation Trust, Liverpool, United Kingdom
| | - Caroline Toolan
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, NHS Foundation Trust, Liverpool, United Kingdom; Department of Cardiothoracic Anaesthesia, Liverpool Heart and Chest Hospital, NHS Foundation Trust, Liverpool, United Kingdom
| | - Kenneth Palmer
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, NHS Foundation Trust, Liverpool, United Kingdom; Department of Cardiothoracic Anaesthesia, Liverpool Heart and Chest Hospital, NHS Foundation Trust, Liverpool, United Kingdom
| | - Omar Al-Rawi
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, NHS Foundation Trust, Liverpool, United Kingdom; Department of Cardiothoracic Anaesthesia, Liverpool Heart and Chest Hospital, NHS Foundation Trust, Liverpool, United Kingdom
| | - Paul Modi
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, NHS Foundation Trust, Liverpool, United Kingdom; Department of Cardiothoracic Anaesthesia, Liverpool Heart and Chest Hospital, NHS Foundation Trust, Liverpool, United Kingdom.
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13
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Cuartas MM, Davierwala PM. Minimally invasive mitral valve repair. Indian J Thorac Cardiovasc Surg 2020; 36:44-52. [PMID: 33061184 DOI: 10.1007/s12055-019-00843-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/25/2019] [Accepted: 05/30/2019] [Indexed: 11/26/2022] Open
Abstract
Minimally invasive mitral valve (MV) repair is being increasingly performed over the last 2 decades due to the constantly growing patient demand, since it offers a shorter recovery, less restriction and faster return to normal physical activities, reduction in pain, and superior cosmetic results. However, such procedures have to be performed through small incisions which limit visualization and the freedom of movement of the surgeon, in contrast to conventional operations that are performed through a sternotomy. Therefore, special long surgical instruments are required, and visualization is usually enhanced with advanced port-access two-dimensional (2D) or three-dimensional (3D) thoracoscopic cameras. This makes performance of a minimally invasive MV repair more challenging for the surgeon and is thereby associated with a steep learning curve. Nonetheless, the vast majority of patients who require MV repair are usually good candidates for this less invasive technique, though adequate patient selection is of utmost importance for success. Concomitant cardiac procedures such as ablation surgery for atrial fibrillation or right-sided interventions such as tricuspid valve surgery, heart tumor resection, and atrial septal defect closure can easily be performed using this approach. Short- and long-term results after minimally invasive MV repair are excellent and comparable with those achieved through a sternotomy approach. There are few drawbacks associated with minimally invasive MV repair such as the high technical demands of working through a constrained space and development of complications associated with peripheral cannulation and seldom unilateral pulmonary edema. Nonetheless, high-volume centers have been able to achieve similar operating times, postoperative complication rates, and mid-/long-term outcomes to those obtained through conventional sternotomy. Up-to-date evidence is needed in order to improve recommendations supporting minimally invasive MV repair. Future innovations should concentrate on decreasing complexity and improving reproducibility of minimally invasive procedures in low-volume centers.
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Affiliation(s)
- Mateo Marin Cuartas
- University Department for Cardiac Surgery, Leipzig Heart Center, Struempellstrasse 39, 04289 Leipzig, Germany
| | - Piroze Minoo Davierwala
- University Department for Cardiac Surgery, Leipzig Heart Center, Struempellstrasse 39, 04289 Leipzig, Germany
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14
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Brown LJ, Mellor SL, Niranjan G, Harky A. Outcomes in minimally invasive double valve surgery. J Card Surg 2020; 35:3486-3502. [PMID: 32906191 DOI: 10.1111/jocs.14997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/08/2020] [Accepted: 08/24/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To review current literature evidence on outcomes of minimally invasive double valve surgeries (MIS). METHODS A comprehensive electronic literature search was done from inception to 20th June 2020 identifying articles that discussed outcomes of minimally invasive approach in double valve surgeries either as a solo cohort or as comparative to conventional sternotomies. No limit was placed on time and place of publication and the evidence has been summarized in narrative manner within the manuscript. RESULTS Majority of current literature reported similar perioperative and clinical outcomes between MIS and conventional median sternotomy; except that MIS has better cosmetic effects and pain control. Nevertheless, minimal invasive techniques are associated with longer cardiopulmonary bypass and aortic cross-clamp times which may have impact on the reported outcomes and overall morbidity and mortality rates. CONCLUSION Minimally invasive double valve surgery continues to develop, but scarcity in the literature suggests uptake is slow, possibly due to the learning curve associated with MIS. Many outcomes appear to be comparable to conventional sternotomy. There is need for larger, multi-center, and randomized trial to fully evaluate and establish the early, mid- and long-term morbidity and mortality rates associated with both techniques.
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Affiliation(s)
- Louise J Brown
- Birmingham Medical School, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Sophie L Mellor
- Birmingham Medical School, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Gunaratnam Niranjan
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest, Liverpool, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest, Liverpool, UK.,Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
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15
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Vervoort D, Nguyen DH, Nguyen TC. When Culture Dictates Practice: Adoption of Minimally Invasive Mitral Valve Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2020; 15:406-409. [DOI: 10.1177/1556984520948644] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Dominique Vervoort
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, MD, USA
| | - Dinh Hoang Nguyen
- Department of Cardiovascular Surgery, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Tom C. Nguyen
- Department of Cardiothoracic and Vascular Surgery, University of Texas Health Science Center Houston, McGovern Medical School, TX, USA
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16
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Mohammed H, Yousuf Salmasi M, Caputo M, Angelini GD, Vohra HA. Comparison of outcomes between minimally invasive and median sternotomy for double and triple valve surgery: A meta-analysis. J Card Surg 2020; 35:1209-1219. [PMID: 32306504 DOI: 10.1111/jocs.14558] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 03/31/2020] [Accepted: 04/06/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Limited data exists demonstrating the efficacy of minimally invasive surgery (MIS) compared to median sternotomy (MS) for multiple valvular disease (MVD). This systematic review and meta-analysis aims to compare operative and peri-operative outcomes of MIS vs MS in MVD. METHODS PubMed, Ovid, and Embase were searched from inception until August 2019 for randomized and observational studies comparing MIS and MS in patients with MVD. Clinical outcomes of intra- and postoperative times, reoperation for bleeding and surgical site infection were evaluated. RESULTS Five observational studies comparing 340 MIS vs 414 MS patients were eligible for qualitative and quantitative review. The quality of evidence assessed using the Newcastle-Ottawa scale was good for all included studies. Meta-analysis demonstrated increased cardiopulmonary bypass time for MIS patients (weighted mean difference [WMD], 0.487; 95% confidence interval [CI], 0.365-0.608; P < .0001). Similarly, aortic cross-clamp time was longer in patients undergoing MIS (WMD, 0.632; 95% CI, 0.509-0.755; P < .0001). No differences were found in operative mortality, reoperation for bleeding, surgical site infection, or hospital stay. CONCLUSIONS MIS for MVD have similar short-term outcomes compared to MS. This adds value to the use of minimally invasive methods for multivalvular surgery, despite conferring longer operative times. However, the paucity in literature and learning curve associated with MIS warrants further evidence, ideally randomized control trials, to support these findings.
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Affiliation(s)
- Haya Mohammed
- Faculty of Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Massimo Caputo
- Department of Cardiovascular Sciences, Bristol Heart Institute, University Hospitals Bristol, Bristol, UK
| | - Gianni D Angelini
- Department of Cardiovascular Sciences, Bristol Heart Institute, University Hospitals Bristol, Bristol, UK
| | - Hunaid A Vohra
- Department of Cardiovascular Sciences, Bristol Heart Institute, University Hospitals Bristol, Bristol, UK
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17
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Wyler von Ballmoos MC. Minimally invasive mitral valve surgery to maximally benefit patients-what is the key to success today and tomorrow? ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:162. [PMID: 32309309 PMCID: PMC7154438 DOI: 10.21037/atm.2019.11.83] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Moritz C Wyler von Ballmoos
- Department of Cardiothoracic Surgery, DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA.,Weill Cornell Medicine, New York, NY, USA
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18
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Prabhu NK, Andersen ND, Turek JW. Reply: Taking surgical advancements in the developing world to heart—a case for trickle-up innovation? J Thorac Cardiovasc Surg 2020; 159:e245-e246. [DOI: 10.1016/j.jtcvs.2019.09.072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 09/23/2019] [Indexed: 11/24/2022]
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19
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Williams RD, Foley NM, Vyas R, Huang S, Kertai MD, Balsara KR, Petracek MR, Shah AS, Absi TS. Predictors of Stroke After Minimally Invasive Mitral Valve Surgery Without the Cross-Clamp. Semin Thorac Cardiovasc Surg 2020; 32:47-56. [DOI: 10.1053/j.semtcvs.2019.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 09/04/2019] [Indexed: 11/11/2022]
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20
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Kastengren M, Svenarud P, Ahlsson A, Dalén M. Minimally invasive mitral valve surgery is associated with a low rate of complications. J Intern Med 2019; 286:614-626. [PMID: 31502720 DOI: 10.1111/joim.12974] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Minimally invasive mitral valve surgery is generally performed through a right minithoracotomy, in contrast to the traditional full median sternotomy approach. Minimally invasive mitral valve surgery is performed with increasing frequency, and by reducing surgical trauma, several observational studies suggest potential benefits with decreased bleeding and postoperative pain, reduced incidence of sternal wound infections, reduced length of hospital stay and shortened recovery period after surgery. In this review, we present an overview of mitral valve surgery, summarize the available evidence regarding the minimally invasive approach and report our experiences from introducing a minimally invasive mitral valve surgery programme at the Karolinska University Hospital in Stockholm, Sweden.
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Affiliation(s)
- M Kastengren
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - P Svenarud
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiac Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - A Ahlsson
- Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - M Dalén
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiac Surgery, Karolinska University Hospital, Stockholm, Sweden
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21
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The first 5 years: Building a minimally invasive valve program. J Thorac Cardiovasc Surg 2019; 157:1958-1965. [DOI: 10.1016/j.jtcvs.2018.10.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 09/24/2018] [Accepted: 10/03/2018] [Indexed: 12/20/2022]
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22
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Peiffer V, Yock CA, Yock PG, Pietzsch JB. Value-Based Care: A Review of Key Challenges and Opportunities Relevant to Medical Technology Innovators. J Med Device 2019. [DOI: 10.1115/1.4042794] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Developed countries struggle with high healthcare spending, and cost is often cited as a barrier to the introduction of new patient care technologies. The core objective of this review article is to help familiarize medical technology innovators with trends in the health economic environment and the implications for the adoption of new technologies. We review and discuss this topic in language accessible to medical technology innovators. We assess macrolevel developments in healthcare spending and highlight measures already taken to control spending. We discuss practical implications for anyone involved in healthcare innovation. Two observations are central to this discussion: (1) the U.S. spends significantly more on healthcare per capita than any other developed country; (2) across developed countries, healthcare spending has risen steadily over the past two decades. Nevertheless, higher spending has not always led to improvements in health. As a result, innovators need to be prepared to navigate an outcomes-oriented and value-based environment that is being defined by the emerging requirements of various healthcare stakeholders. Practically, new products should aim to improve health outcomes at a cost deemed “good value” and/or reduce cost for one or multiple stakeholders. Opportunities also exist for tools that enable cost/outcomes tracking, which will help demonstrate value to providers, insurers, and patients.
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Affiliation(s)
| | - Cynthia A. Yock
- Byers Center for Biodesign, Stanford University, Stanford, CA 94305
| | - Paul G. Yock
- Byers Center for Biodesign, Stanford University, Stanford, CA 94305
| | - Jan B. Pietzsch
- Wing Tech, Inc., Menlo Park, CA 94025; Byers Center for Biodesign, Stanford University, Clark Center (E100) 318 Campus Drive, Stanford, CA 94305 e-mail:
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23
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Wu X, Wei W, He Y, Qin H, Qi F. Analysis of the Learning Curve in Mitral Valve Replacement Through the Right Anterolateral Minithoracotomy Approach: A Surgeon’s Experience with the First 100 Patients. Heart Lung Circ 2019; 28:471-476. [DOI: 10.1016/j.hlc.2018.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 02/05/2018] [Indexed: 11/29/2022]
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24
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Han JJ, Atluri P. The invisible hands conducting minimally invasive mitral valve surgery. J Thorac Cardiovasc Surg 2018; 156:617-618. [PMID: 29754797 DOI: 10.1016/j.jtcvs.2018.04.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 04/11/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Jason J Han
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Pavan Atluri
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa.
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Minimally invasive mitral valve surgery is associated with excellent resource utilization, cost, and outcomes. J Thorac Cardiovasc Surg 2018; 156:611-616.e3. [PMID: 29709359 DOI: 10.1016/j.jtcvs.2018.03.108] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 03/12/2018] [Accepted: 03/25/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Minimally invasive mitral valve surgery (mini-MVR) has numerous associated benefits. However, many studies fail to include greater-risk patients. We hypothesized that a minimally invasive approach in a representative cohort provides excellent outcomes with reduced resource utilization. METHODS Mitral valve surgical records from 2011 to 2016 were paired with institutional financial records. Patients were stratified by approach and propensity-score matched to balance preoperative difference. The primary outcomes of interest were resource utilization including cost, discharge to a facility, and readmission. RESULTS A total of 478 patients underwent mitral surgery (21% mini-MVR) and were balanced after matching (n = 74 per group), with 18% of patients having nondegenerative mitral disease. Outcomes were excellent with similar rates of major morbidity (9.5% mini-MVR vs 10.8% conventional, P = .78). Mini-MVR cases had lower rates of transfusion (11% vs 27%, P = .01) and shorter ventilator times (3.7 vs 6.0 hours, P < .0001). Mean total hospital cost was equivalent ($49,703 vs $54,970, P = .235) with mini-MVR having lower ancillary ($1645 vs $2652, P = .001) and blood costs ($383 vs $1058, P = .001). These savings were offset by longer surgical times (291 vs 234 minutes, P < .0001) with greater surgical ($7645 vs $7293, P = .0001) and implant costs ($1148 vs $748, P = .03). Rates of discharge to a facility (9.6% vs 16.2%) and readmission (9.6% vs 4.1%) were not statistically different. CONCLUSIONS In a real-world cohort, mini-MVR continues to demonstrate excellent results with a favorable resource utilization profile. Greater surgical and implant costs with mini-MVR are offset by decreased transfusions and ancillary needs leading to equivalent overall hospital cost.
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Wang Q, Xi W, Gao Y, Shen H, Min J, Yang J, Le S, Zhang Y, Wang Z. Short-term outcomes of minimally invasive mitral valve repair: a propensity-matched comparison. Interact Cardiovasc Thorac Surg 2018; 26:805-812. [PMID: 29304201 DOI: 10.1093/icvts/ivx402] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 11/19/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Qing Wang
- Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Wang Xi
- Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yang Gao
- Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Hua Shen
- Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jie Min
- Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jie Yang
- Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Shiguan Le
- Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yufeng Zhang
- Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Zhinong Wang
- Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
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Goldstone AB, Woo YJ. Is minimally invasive thoracoscopic surgery the new benchmark for treating mitral valve disease? Ann Cardiothorac Surg 2016; 5:567-572. [PMID: 27942489 DOI: 10.21037/acs.2016.03.18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The treatment of mitral valve disease remains dynamic; surgeons and patients must now choose between many different surgical options when addressing mitral regurgitation and mitral stenosis. Notably, advances in imaging and surgical instrumentation allow surgeons to perform less invasive mitral valve surgery that spares the sternum. With favorable long-term data now emerging, we compare the benefits and risks of thoracoscopic mitral valve surgery with that through conventional sternotomy or surgery that is robot-assisted.
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Affiliation(s)
- Andrew B Goldstone
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Y Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA
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Nagendran J, Catrip J, Losenno KL, Adams C, Kiaii B, Chu MW. Minimally invasive mitral repair surgery: why does controversy still persist? Expert Rev Cardiovasc Ther 2016; 15:15-24. [DOI: 10.1080/14779072.2017.1266936] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Jeevan Nagendran
- Division of Cardiac Surgery, Department of Surgery, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - Jorge Catrip
- Department of Cardiovascular Surgery, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico
| | - Katie L. Losenno
- Division of Cardiac Surgery, Department of Surgery, Lawson Health Research Institute, Western University, London, Canada
| | - Corey Adams
- Division of Cardiac Surgery, Department of Surgery, Health Science Center, Memorial University, St. John’s, Canada
| | - Bob Kiaii
- Division of Cardiac Surgery, Department of Surgery, Lawson Health Research Institute, Western University, London, Canada
| | - Michael W.A. Chu
- Division of Cardiac Surgery, Department of Surgery, Lawson Health Research Institute, Western University, London, Canada
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Myocardial Protection and Financial Considerations of Custodiol Cardioplegia in Minimally Invasive and Open Valve Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016; 11:420-424. [DOI: 10.1097/imi.0000000000000314] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective Single-dose antegrade crystalloid cardioplegia with Custodiol-HTK (histidine-tryptophan-ketoglutarate) has been used for many years. Its safety and efficacy were established in experimental and clinical studies. It is beneficial in complex valve surgery because it provides a long period of myocardial protection with a single dose. Thus, valve procedures (minimally invasive or open) can be performed with limited interruption. The aim of this study is to compare the use of Custodiol-HTK cardioplegia with traditional blood cardioplegia in patients undergoing minimally invasive and open valve surgery. Methods A single-institution, retrospective case-control review was performed on patients who underwent valve surgery in Lee Memorial Health System at either HealthPark Medical Center or Gulf Coast Medical Center from July 1, 2011, through March 7, 2015. A total of 181 valve cases (aortic or mitral) performed using Custodiol-HTK cardioplegia were compared with 181 cases performed with traditional blood cardioplegia. Each group had an equal distribution of minimally invasive and open valve cases. Right chest thoracotomy or partial sternotomy was performed on minimally invasive valve cases. Demographics, perioperative data, clinical outcomes, and financial data were collected and analyzed. Results Patient outcomes were superior in the Custodiol-HTK cardioplegia group for blood transfusion, stroke, and hospital readmission within 30 days (P < 0.05). No statistical differences were observed in the other outcomes categories. Hospital charges were reduced on average by $3013 per patient when using Custodiol-HTK cardioplegia. Conclusions Use of Custodiol-HTK cardioplegia is safe and cost-effective when compared with traditional repetitive blood cardioplegia in patients undergoing minimally invasive and open valve surgery.
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Hummel BW, Buss RW, DiGiorgi PL, Laviano BN, Yaeger NA, Lucas ML, Comas GM. Myocardial Protection and Financial Considerations of Custodiol Cardioplegia in Minimally Invasive and Open Valve Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016. [DOI: 10.1177/155698451601100609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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La cirugía mínimamente invasiva de la válvula mitral a través de toracotomía derecha es un procedimiento seguro y eficaz a corto y largo plazo. Estudio de cohortes ajustadas por nivelación del riesgo de propensión. REVISTA COLOMBIANA DE CARDIOLOGÍA 2016. [DOI: 10.1016/j.rccar.2016.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Naunheim MR, Song PC, Franco RA, Alkire BC, Shrime MG. Surgical management of bilateral vocal fold paralysis: A cost-effectiveness comparison of two treatments. Laryngoscope 2016; 127:691-697. [DOI: 10.1002/lary.26253] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 06/24/2016] [Accepted: 07/20/2016] [Indexed: 12/22/2022]
Affiliation(s)
- Matthew R. Naunheim
- Department of Otolaryngology-Head and Neck Surgery; Massachusetts Eye and Ear Infirmary; Boston Massachusetts U.S.A
- Department of Otology and Laryngology; Harvard Medical School; Boston Massachusetts U.S.A
| | - Phillip C. Song
- Department of Otolaryngology-Head and Neck Surgery; Massachusetts Eye and Ear Infirmary; Boston Massachusetts U.S.A
- Department of Otology and Laryngology; Harvard Medical School; Boston Massachusetts U.S.A
| | - Ramon A. Franco
- Department of Otolaryngology-Head and Neck Surgery; Massachusetts Eye and Ear Infirmary; Boston Massachusetts U.S.A
- Department of Otology and Laryngology; Harvard Medical School; Boston Massachusetts U.S.A
| | - Blake C. Alkire
- Department of Otolaryngology-Head and Neck Surgery; Massachusetts Eye and Ear Infirmary; Boston Massachusetts U.S.A
- Department of Otology and Laryngology; Harvard Medical School; Boston Massachusetts U.S.A
| | - Mark G. Shrime
- Department of Otolaryngology-Head and Neck Surgery; Massachusetts Eye and Ear Infirmary; Boston Massachusetts U.S.A
- Department of Otology and Laryngology; Harvard Medical School; Boston Massachusetts U.S.A
- Department of Global Health and Population; Harvard School of Public Health; Boston Massachusetts U.S.A
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Shamoun FE, Craner RC, Seggern RV, Makar G, Ramakrishna H. Percutaneous and minimally invasive approaches to mitral valve repair for severe mitral regurgitation-new devices and emerging outcomes. Ann Card Anaesth 2016; 18:528-36. [PMID: 26440239 PMCID: PMC4881663 DOI: 10.4103/0971-9784.166462] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Mitral valve disease is common in the United States and around the world, and if left untreated, increases cardiovascular morbidity and mortality. Mitral valve repair is technically more demanding than mitral valve replacement. Mitral valve repair should be considered the first line of treatment for mitral regurgitation in younger patients, mitral valve prolapse, annular dilatation, and with structural damage to the valve. Several minimally invasive percutaneous treatment options for mitral valve repair are available that are not restricted to conventional surgical approaches, and may be better received by patients. A useful classification system of these approaches proposed by Chiam and Ruiz is based on anatomic targets and device action upon the leaflets, annulus, chordae, and left ventricle. Future directions of minimally invasive techniques will include improving the safety profile through patient selection and risk stratification, improvement of current imaging and techniques, and multidisciplinary education.
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Minimally invasive mitral valve surgery: a review of the literature. Indian J Thorac Cardiovasc Surg 2016. [DOI: 10.1007/s12055-016-0433-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Downs EA, Johnston LE, LaPar DJ, Ghanta RK, Kron IL, Speir AM, Fonner CE, Kern JA, Ailawadi G. Minimally Invasive Mitral Valve Surgery Provides Excellent Outcomes Without Increased Cost: A Multi-Institutional Analysis. Ann Thorac Surg 2016; 102:14-21. [PMID: 27041453 DOI: 10.1016/j.athoracsur.2016.01.084] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 01/13/2016] [Accepted: 01/18/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Minimally invasive mitral valve surgery (mini-MVR) has grown in popularity. Although single centers have reported excellent outcomes, data on real-world outcomes and costs of mini-MVR are limited. Moreover, mini-MVR has been criticized as adding additional cost without clear benefit. We hypothesized that mini-MVR provides superior outcomes with incremental increased costs in a multi-institutional cohort. METHODS Records for patients undergoing mitral valve surgical procedures with or without atrial ablation from 2011 to 2014 were extracted from a multi-institutional, regional Society of Thoracic Surgeons database and stratified according to right chest approach/minimally invasive or conventional sternotomy. Patients undergoing coronary artery bypass grafting or other concomitant procedures were excluded. Patients undergoing isolated mitral surgical procedure were propensity matched according to factors, including age, comorbidities, and preoperative laboratory values; clinical outcomes and cost differences were assessed by approach. RESULTS A total of 1,304 patients underwent mitral operations, including 425 (32.6%) by minimally invasive approach. In the propensity-matched analysis (n = 355 per group), patients undergoing mini-MVR had similar rates of mortality, stroke, and other complications compared with conventional MVR. Meanwhile, patients with mini-MVR experienced shorter intensive care unit and hospital lengths of stay and fewer transfusions. Importantly, total hospital costs were no different between the two matched groups. CONCLUSIONS Compared with conventional sternotomy, mini-MVR in the "real world" demonstrated no differences in rates of major morbidity, but it was associated with shorter length of stay and fewer transfusions. Contrary to our hypothesis, mini-MVR can be performed with similar total hospital costs as conventional sternotomy. In summary, minimally invasive mitral surgical procedure in select patients can provide superior outcomes without increased cost.
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Affiliation(s)
- Emily A Downs
- Department of Surgery, Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia
| | - Lily E Johnston
- Department of Surgery, Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia
| | - Damien J LaPar
- Department of Surgery, Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia
| | - Ravi K Ghanta
- Department of Surgery, Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia
| | - Irving L Kron
- Department of Surgery, Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia
| | - Alan M Speir
- Cardiovascular and Thoracic Associates, Inova Heart and Vascular Institute, Falls Church, Virginia
| | - Clifford E Fonner
- Virginia Cardiac Surgery Quality Initiative, Charlottesville, Virginia
| | - John A Kern
- Department of Surgery, Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia
| | - Gorav Ailawadi
- Department of Surgery, Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia.
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Vassileva CM. Minimally invasive mitral repair: The cost is the same, but what is the price? J Thorac Cardiovasc Surg 2016; 151:389-90. [DOI: 10.1016/j.jtcvs.2015.09.134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 09/17/2015] [Indexed: 11/15/2022]
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Abstract
Staphylococcus aureus is a leading pathogen in surgical site, intensive care unit, and skin infections, as well as healthcare-associated pneumonias. These infections are associated with an enormous burden of morbidity, mortality, and increase of hospital length of stay and patient cost. S. aureus is impressively fast in acquiring antibiotic resistance, and multidrug-resistant strains are a serious threat to human health. Due to resistance or insufficient effectiveness, antibiotics and bundle measures leave a tremendous unmet medical need worldwide. There are no licensed vaccines on the market despite the significant efforts done by public and private initiatives. Indeed, vaccines tested in clinical trials in the last two decades have failed to show efficacy. However, they targeted single antigens and contained no adjuvants and efficacy trials were performed in severely ill subjects. Herein, we provide a comprehensive evaluation of potential target populations for efficacy trials taking into account key factors such as population size, incidence of S. aureus infection, disease outcome, primary endpoints, as well as practical advantages and disadvantages. We describe the whole-blood assay as a potential surrogate of protection, and we show the link between phase III clinical trial data of failed vaccines with their preclinical observations. Finally, we give our perspective on how new vaccine formulations and clinical development approaches may lead to successful S. aureus vaccines.
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Cheng A. Minimally invasive left ventricular assist device placement. J Vis Surg 2015; 1:25. [PMID: 29075614 DOI: 10.3978/j.issn.2221-2965.2015.12.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 11/23/2015] [Indexed: 11/14/2022]
Abstract
BACKGROUND The use of left ventricular assist device (LVAD) as bridge-to-transplant and destination therapy has increased significantly in the recent years along with the rapidly increasing heart failure patient population worldwide. It is crucial to be familiar with the standard surgical technique of LVAD implantation, but also to further advance the technique to optimize patient outcomes. Numerous studies have shown minimally invasive cardiac surgeries, including cardiac valves procedures can improve patient outcomes with decrease post-operative bleeding, reduced blood transfusion requirement, shorter hospital stay, faster recovery rate and lower hospital cost. With the advancement of mechanical circulatory support, the smaller and current generation of centrifugal continuous-flow LVADs has made minimally invasive LVAD implantation feasible. In this review, we described our surgical technique of minimally invasive LVAD placement. METHODS In addition to the standard pre-LVAD implantation evaluation, multiple studies, including chest radiography, chest computed tomography and echocardiography are further examined for patient selection and planning of the operation. Instead of a full standard sternotomy, a lateral mini-thoracotomy and hemi-sternotomy or second intercostal space anterior mini-thoracotomy are utilized. Special techniques are also applied to allow easy access for future re-entry, e.g., heart transplantation and to improve post-operative outcomes. Off-pump approach is our prefer approach for the minimally invasive procedure. RESULTS With minimally invasive approach, avoiding a full sternotomy, can reduce surgical trauma and post-operative bleeding, and can make subsequent LVAD explantation and heart transplantation less technically challenging and will allow patients to have a faster post-operative recovery rate. With the intact pericardium, the right ventricle can be protected from acute unrestricted dilation and further right heart failure after LVAD placement. The use of off-pump approach allows the avoidance of cardiopulmonary bypass and will decrease the incidence of post-operative vasoplegia and coagulopathy. CONCLUSIONS With the current generation of LVADs, minimally invasive surgical approach is very feasible and may improve patient outcomes. Further large prospective randomized studies will help to further demonstrate the potential advantages and disadvantage of minimally invasive LVAD placement. The upcoming generations of LVADs and minimally invasive instrumentations are currently being evaluate and will further advance the success of LVAD therapy.
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Affiliation(s)
- Allen Cheng
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, USA
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Sorabella RA, Argenziano M. Minimally invasive mitral valve repair through a right minithoracotomy approach. Ann Cardiothorac Surg 2015; 4:478-9. [PMID: 26539356 DOI: 10.3978/j.issn.2225-319x.2014.12.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Robert A Sorabella
- Division of Cardiothoracic Surgery, College of Physicians and Surgeons of Columbia University, New York-Presbyterian Hospital, New York 10032, USA
| | - Michael Argenziano
- Division of Cardiothoracic Surgery, College of Physicians and Surgeons of Columbia University, New York-Presbyterian Hospital, New York 10032, USA
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Santana O, Larrauri-Reyes M, Zamora C, Mihos CG. Is a minimally invasive approach for mitral valve surgery more cost-effective than median sternotomy?: Table 1:. Interact Cardiovasc Thorac Surg 2015; 22:97-100. [DOI: 10.1093/icvts/ivv269] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 08/24/2015] [Indexed: 11/13/2022] Open
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Melnitchouk SI, Dal-Bianco JP, Borger MA. Minimally Invasive Mitral Valve Surgery via Mini-Thoracotomy: Current Update. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2015; 17:48. [DOI: 10.1007/s11936-015-0406-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Atluri P, Stetson RL, Hung G, Gaffey AC, Szeto WY, Acker MA, Hargrove WC. Minimally invasive mitral valve surgery is associated with equivalent cost and shorter hospital stay when compared with traditional sternotomy. J Thorac Cardiovasc Surg 2015; 151:385-8. [PMID: 26432722 DOI: 10.1016/j.jtcvs.2015.08.106] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 07/30/2015] [Accepted: 08/29/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Mitral valve surgery is increasingly performed through minimally invasive approaches. There are limited data regarding the cost of minimally invasive mitral valve surgery. Moreover, there are no data on the specific costs associated with mitral valve surgery. We undertook this study to compare the costs (total and subcomponent) of minimally invasive mitral valve surgery relative to traditional sternotomy. METHODS All isolated mitral valve repairs performed in our health system from March 2012 through September 2013 were analyzed. To ensure like sets of patients, only those patients who underwent isolated mitral valve repairs with preoperative Society of Thoracic Surgeons scores of less than 4 were included in this study. A total of 159 patients were identified (sternotomy, 68; mini, 91). Total incurred direct cost was obtained from hospital financial records. RESULTS Analysis demonstrated no difference in total cost (operative and postoperative) of mitral valve repair between mini and sternotomy ($25,515 ± $7598 vs $26,049 ± $11,737; P = .74). Operative costs were higher for the mini cohort, whereas postoperative costs were significantly lower. Postoperative intensive care unit and total hospital stays were both significantly shorter for the mini cohort. There were no differences in postoperative complications or survival between groups. CONCLUSIONS Minimally invasive mitral valve surgery can be performed with overall equivalent cost and shorter hospital stay relative to traditional sternotomy. There is greater operative cost associated with minimally invasive mitral valve surgery that is offset by shorter intensive care unit and hospital stays.
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Affiliation(s)
- Pavan Atluri
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa.
| | - Robert L Stetson
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa
| | - George Hung
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Ann C Gaffey
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Wilson Y Szeto
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Michael A Acker
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa
| | - W Clark Hargrove
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa
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Nguyen TC, Lamelas J. From the ground up: building a minimally invasive aortic valve surgery program. Ann Cardiothorac Surg 2015; 4:178-81. [PMID: 25870815 DOI: 10.3978/j.issn.2225-319x.2015.03.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 12/21/2014] [Indexed: 01/22/2023]
Abstract
Minimally invasive aortic valve replacement (MIAVR) is associated with numerous advantages including improved patient satisfaction, cosmesis, decreased transfusion requirements, and cost-effectiveness. Despite these advantages, little information exists on how to build a MIAVR program from the ground up. The steps to build a MIAVR program include compiling a multi-disciplinary team composed of surgeons, cardiologists, anesthesiologists, perfusionists, operating room (OR) technicians, and nurses. Once assembled, this team can then approach hospital administrators to present a cost-benefit analysis of MIAVR, emphasizing the importance of reduced resource utilization in the long-term to offset the initial financial investment that will be required. With hospital approval, training can commence to provide surgeons and other staff with the necessary knowledge and skills in MIAVR procedures and outcomes. Marketing and advertising of the program through the use of social media, educational conferences, grand rounds, and printed media will attract the initial patients. A dedicated website for the program can function as a "virtual lobby" for patients wanting to learn more. Initially, conservative selection criteria of cases that qualify for MIAVR will set the program up for success by avoiding complex co-morbidities and surgical techniques. During the learning curve phase of the program, patient safety should be a priority.
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Affiliation(s)
- Tom C Nguyen
- 1 Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, Memorial Hermann Hospital, Heart and Vascular Institute, Houston, Texas, USA ; 2 Division of Cardiac Surgery, Mount Sinai Medical Center, Miami Beach, Florida, USA
| | - Joseph Lamelas
- 1 Department of Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, Memorial Hermann Hospital, Heart and Vascular Institute, Houston, Texas, USA ; 2 Division of Cardiac Surgery, Mount Sinai Medical Center, Miami Beach, Florida, USA
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Abstract
BACKGROUND Thymectomy is a widely accepted treatment for most cases of myasthenia gravis and essential for the treatment of thymoma. The development of a minimally invasive procedure for thymectomy resulted in a variety of approaches for surgery on the thymic gland. The use of thoracoscopy-based techniques has continued to increase, including the latest advance in this field, robotic thymectomy. METHODS We review the rapid development and actual use of this approach by examining published reports, worldwide registries, and personal communications and by analyzing our database, which is the largest single-center experience and contains 317 thymectomies until 12/2012. The technical modifications of robotic thymectomy are also described. RESULTS Since 2001, approximately 3,500 robotic thymectomies have been registered worldwide. Meanwhile, the results of approximately 500 thymectomy cases have been published. Robotic thymectomy is performed most frequently through a standardized unilateral three-trocar approach. All reports describe promising and satisfactory results for myasthenia gravis. For early-stage thymoma, robotic thymectomy is a technically sound and safe procedure with a very low complication rate and short hospital stay. Oncological outcome without recurrences is promising, but a longer follow-up is needed. CONCLUSION The unilateral robotic technique can be considered an adequate approach for thymectomy, even with demanding anatomical configurations. Robotic thymectomy has spread worldwide over the last decade because of the promising results in myasthenia gravis and thymoma patients.
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Affiliation(s)
- Mahmoud Ismail
- Department of General, Visceral, Vascular and Thoracic Surgery, Universitätsmedizin Berlin - Charitè Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany
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Hassan M, Miao Y, Lincoln J, Ricci M. Cost-Benefit Analysis of Robotic versus Nonrobotic Minimally Invasive Mitral Valve Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2015. [DOI: 10.1177/155698451501000203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Mohammed Hassan
- Division of Cardiothoracic Surgery, Department of Surgery, University of New Mexico, Albuquerque, NM USA
| | - Yongjie Miao
- Center for Cardiovascular and Pulmonary Research, Nationwide Children's Hospital Research Institute, Department of Pediatrics, The Ohio State University, Columbus, OH USA
| | - Joy Lincoln
- Center for Cardiovascular and Pulmonary Research, Nationwide Children's Hospital Research Institute, Department of Pediatrics, The Ohio State University, Columbus, OH USA
| | - Marco Ricci
- Division of Cardiothoracic Surgery, Department of Surgery, University of New Mexico, Albuquerque, NM USA
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Cost-Benefit Analysis of Robotic versus Nonrobotic Minimally Invasive Mitral Valve Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2015; 10:90-5. [DOI: 10.1097/imi.0000000000000136] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective To date, a direct comparison of minimally invasive mitral valve repair or replacement (mini-MVR) versus robotic MVR is lacking; therefore, the purpose of this study was to address this deficit and compare mini-MVR with robotic MVR from a cost-benefit perspective. Methods From a total of 759 literature citations, 21 studies were included for statistical comparisons of benefit outcomes, whereas 3 studies and our institutional experience were used to compare costs. Results The total cost per case exceeding that of conventional MVR is approximately $2063.90 for robotic MVR and $271 for mini-MVR. Mean 30-day mortality rates for mini-MVR and robotic MVR groups were 1.24% and 0.55%, respectively [106/8548 vs 6/1089; odds ratio (OR), 2.27; P = 0.052]. The conversion rate to conventional MVR was 0.77% in mini-MVR and 1.83% in robotic MVR (35/5092 vs 22/1046; OR, 0.32; P < 0.001). The rate of neurologic events was 1.32% in mini-MVR and 2.37% in robotic MVR (109/8257 vs 20/845; OR, 0.55; P = 0.02). Postoperative atrial fibrillation was seen in 11.42% of mini-MVR patients and in 19.67% of robotic MVR patients (371/3249 vs 203/1032; OR, 0.53, P < 0.001). Mean cardiopulmonary bypass time was longer in mini-MVR (137.4 vs 130.4 minutes), whereas cross-clamp time was shorter (82.2 vs 96.7 minutes). Conclusions Our comparative analysis provides insights into the clinical benefits versus variable costs relationship related to mini-MVR and robotic MVR.
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Sündermann SH, Czerny M, Falk V. Open vs. Minimally Invasive Mitral Valve Surgery: Surgical Technique, Indications and Results. Cardiovasc Eng Technol 2015; 6:160-6. [PMID: 26577232 DOI: 10.1007/s13239-015-0210-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 01/08/2015] [Indexed: 10/24/2022]
Abstract
Minimally invasive procedures are the standard approach in many centres but are still under debate in regards of inferiority compared to conventional mitral valve surgery through a median sternotomy. The aim of this review was to summarize the current literature comparing minimally invasive mitral valve surgery (MIVS) and conventional mitral valve surgery. In this review of the current literature, we summarize our findings from a recent meta-analysis and add information from papers that were published afterwards. There were no differences between patients treated minimally invasive or through a conventional sternotomy approach in regards of perioperative stroke rate and mortality. Procedural time, cardio-pulmonary-bypass time and cross-clamp time were longer in the MIVS group. In contrast, length of intensive care unit (ICU) stay and length of in hospital stay were significantly reduced in this group. Need for blood transfusion was lower in the MIVS group. Other outcomes like i.e., the rate of rethoracotomies or renal failure didn't differ between the groups. Repair rates and long-term freedom from recurrence of mitral regurgitation and reoperation are similar. Newer publications underline these findings. The current literature shows that MIVS and conventional mitral valve surgery show a similar perioperative outcome. Minimally invasive mitral valve surgery is favourable with regards to ICU stay, in hospital stay as well as need for blood transfusion.
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Affiliation(s)
- Simon H Sündermann
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin (German Heart Institute Berlin), Augustenburgr Platz 1, 13353, Berlin, Germany.
| | - Martin Czerny
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin (German Heart Institute Berlin), Augustenburgr Platz 1, 13353, Berlin, Germany
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Algarni KD, Suri RM, Schaff H. Minimally invasive mitral valve surgery: Does it make a difference? Trends Cardiovasc Med 2014; 25:456-65. [PMID: 25640311 DOI: 10.1016/j.tcm.2014.12.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 12/10/2014] [Accepted: 12/12/2014] [Indexed: 11/24/2022]
Abstract
Minimally invasive mitral valve surgery (MIMVS) has emerged as an alternative approach to conventional sternotomy to perform mitral valve repair and replacement with equivalent results. This strategy was developed to decrease surgical trauma by minimizing the size of incisions and permits excellent exposure of the mitral valve thereby avoiding conventional full sternotomy. The purpose of this review is to provide a critical, objective, balanced, and evidence-based analysis of the literature to understand advantages, potential scope, and the utility of these minimally invasive approaches to the mitral valve in modern cardiac care.
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Affiliation(s)
- Khaled D Algarni
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN; King Saud University, Riyadh, Saudi Arabia
| | - Rakesh M Suri
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN.
| | - Hartzell Schaff
- Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
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Sündermann SH, Sromicki J, Rodriguez Cetina Biefer H, Seifert B, Holubec T, Falk V, Jacobs S. Mitral valve surgery: Right lateral minithoracotomy or sternotomy? A systematic review and meta-analysis. J Thorac Cardiovasc Surg 2014; 148:1989-1995.e4. [DOI: 10.1016/j.jtcvs.2014.01.046] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 01/19/2014] [Accepted: 01/30/2014] [Indexed: 11/28/2022]
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Mariscalco G, Musumeci F. The Minithoracotomy Approach: A Safe and Effective Alternative for Heart Valve Surgery. Ann Thorac Surg 2014; 97:356-64. [DOI: 10.1016/j.athoracsur.2013.09.090] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Revised: 09/22/2013] [Accepted: 09/24/2013] [Indexed: 10/26/2022]
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