Minimally invasive cardiac surgery for cardiac atrioventricular valve reoperation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 HE Weilai , LI Xin , CHE Hong , JIN Chaolong , DONG Wenpeng , LI Feng , LI Yanli , LIN Min , GE Shenglin , ZHOU Ruyuan

Department of Cardiovascular Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, P. R. China;

Corresponding author：

HE Weilai, Email: hewl2022@126.com

Keywords：

Minimally invasive cardiac surgery; cardiac reoperation; cardiopulmonary bypass

DOI：

10.7507/1007-4848.202010095

Video：

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Objective To summarize the clinical experiences of minimally invasive cardiac surgery (MICS) for cardiac atrioventricular valve reoperation.Methods Perioperative data of 32 patients who underwent MICS for cardiac atrioventricular valve reoperation from 2009 to 2019 in the First Affiliated Hospital of Anhui Medical University were retrospectively reviewed, including 13 males and 19 females with a mean age of 51.0±12.6 years. All patients were given combined intravenous and inhalation anesthesia, and a double-lumen tube for mechanical ventilation. Cardiopulmonary bypass was established in all patients by femoral artery and venous cannulation or combined with percutaneous superior vena cava cannulation, without aortic cross-clamping. The MICS approaches included right anterolateral small incision surgery, thoracoscopic assisted small incision surgery and total thoracoscopic surgery. The clinical data of the 32 patients were compared with the perioperative indicators of 24 patients undergoing reoperation with conventional median thoracotomy during the same period.Results Among them, 21 patients underwent isolated tricuspid valve replacement, 4 isolated tricuspid valvuloplasty, 1 combined tricuspid valve replacement and atrial septal defect repair and 6 combined mitral valve replacement and tricuspid valvuloplasty. Twenty-seven patients completed the operation in a beating heart, and 5 under the condition of ventricular fibrillation. Operation time (3.23±1.56 h vs. 5.46±2.13 h, P<0.001), postoperative mechanical ventilation time (9.19±5.40 h vs. 43.23±21.74 h, P<0.001), ICU stay (35.03±18.26 h vs. 79.15±22.43 h, P<0.001) and hospital stay of patients with minimally invasive surgery (9.35±6.43 d vs. 15.85±7.56 d, P=0.001) were shorter than those with median thoracotomy. And the extracorporeal circulation time was not significantly prolonged. There were 4 perioperative complications in patients with minimally invasive surgery, and 1 died in hospital after operation.Conclusion MICS for cardiac atrioventricular valve reoperation can avoid the risk of median sternotomy and separation of cardiac scar adhesion. Especially, total thoracoscopic surgery has more advantages when compared with other operations, including less trauma, less myocardial ischemia reperfusion injury, more rapid recovery and fewer postoperative complications. Total thoracoscopic surgery may be the development direction of MICS for cardiac atrioventricular valve reoperation. However we should take effective and feasible measures to solve the problems caused by cardiopulmonary bypass.

Citation： HE Weilai, LI Xin, CHE Hong, JIN Chaolong, DONG Wenpeng, LI Feng, LI Yanli, LIN Min, GE Shenglin, ZHOU Ruyuan. Minimally invasive cardiac surgery for cardiac atrioventricular valve reoperation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(6): 755-760. doi: 10.7507/1007-4848.202010095 Copy

1.	Jiang Z, Mei J, Ding F, et al. Application of endovascular occlusion of both caval veins in minimally invasive isolated redo tricuspid surgery through right thoracotomy. Heart Lung Circ, 2014, 23(2): 186-189.
2.	Casselman FP, La Meir M, Jeanmart H, et al. Endoscopic mitral and tricuspid valve surgery after previous cardiac surgery. Circulation, 2007, 116(11 Suppl): I270-I275.
3.	Kim HR, Kim GS, Yoo JS, et al. Minimally invasive approach for redo mitral valve replacement: No aortic cross-clamping and no cardioplegia. Korean J Thorac Cardiovasc Surg, 2015, 48(2): 126-128.
4.	Ma ZS, Yang CY, Dong MF, et al. Totally thoracoscopic closure of ventricular septal defect without a robotically assisted surgical system: A summary of 119 cases. J Thorac Cardiovasc Surg, 2014, 147(3): 863-867.
5.	Chow SC, Lee AP, Ho AM, et al. Redo tricuspid valve operation in patients with 1 ST-generation mitral prostheses. Asian Cardiovasc Thorac Ann, 2018, 26(7): 524-528.
6.	王崇, 韩林, 陆方林, 等. 再次心脏瓣膜手术 325 例临床分析. 中国胸心血管外科临床杂志, 2013, 20(1): 24-28.
7.	Färber G, Tkebuchava S, Dawson RS, et al. Minimally invasive, isolated tricuspid valve redo surgery: A safety and outcome analysis. Thorac Cardiovasc Surg, 2018, 66(7): 564-571.
8.	Fatehi Hassanabad A, Turcotte M, Dennehy C, et al. Contemporary reoperative mitral valve surgery: Technical considerations and clinical outcomes. Innovations (Phila), 2020, 15(5): 425-439.
9.	Huang LC, Chen DZ, Chen LW, et al. Health-related quality of life following minimally invasive totally endoscopic mitral valve surgery. J Cardiothorac Surg, 2020, 15(1): 194.
10.	Kervan U, Cicekcioglu F, Tuluce H, et al. Comparison of neurocognitive functions after beating-heart mitral valve replacement without aorta cross-clamping and after standard mitral valve replacement with cardioplegic arrest. Heart Surg Forum, 2011, 14(6): E335-E339.
11.	Pasic M, Sündermann S, Unbehaun A, et al. Beating heart mitral valve surgery: Results in 120 consecutive patients considered unsuitable for conventional mitral valve surgery. Interact Cardiovasc Thorac Surg, 2017, 25(4): 541-547.
12.	Peters AC, Unger E, Gong FF, et al. Multimodality imaging to guide transcatheter treatment of severe degenerative tricuspid regurgitation with tricuspid valve-in-ring implantation and paravalvular leak closure. Echocardiography, 2020, 37(6): 913-916.
13.	Vallabhajosyula P, Wallen TJ, Solometo LP, et al. Minimally invasive mitral valve surgery utilizing heart port technology. J Card Surg, 2014, 29(3): 343-348.
14.	Botta L, Cannata A, Fratto P, et al. The role of the minimally invasive beating heart technique in reoperative valve surgery. J Card Surg, 2012, 27(1): 24-28.
15.	黄焕雷, 柯英杰, 杨亮, 等. 微创成形技术治疗心脏手术后重度三尖瓣关闭不全的中期疗效分析. 中华外科杂志, 2019, 57(12): 902-907.
16.	Zhang H, Xu HS, Wen B, et al. Minimally invasive beating heart technique for mitral valve surgery in patients with previous sternotomy and giant left ventricle. J Cardiothorac Surg, 2020, 15(1): 122.
17.	Fleißner F, Salman J, Naqizadah J, et al. Minimally invasive surgery in mitral valve endocarditis. Thorac Cardiovasc Surg, 2019, 67(8): 637-643.
18.	Xu RB, Rahnavardi M, Nadal M, et al. Beating heart minimally invasive mitral valve surgery in patients with previous sternotomy: The operative technique and early outcomes. Open Heart, 2018, 5(1): e000749.

1. Jiang Z, Mei J, Ding F, et al. Application of endovascular occlusion of both caval veins in minimally invasive isolated redo tricuspid surgery through right thoracotomy. Heart Lung Circ, 2014, 23(2): 186-189.
2. Casselman FP, La Meir M, Jeanmart H, et al. Endoscopic mitral and tricuspid valve surgery after previous cardiac surgery. Circulation, 2007, 116(11 Suppl): I270-I275.
3. Kim HR, Kim GS, Yoo JS, et al. Minimally invasive approach for redo mitral valve replacement: No aortic cross-clamping and no cardioplegia. Korean J Thorac Cardiovasc Surg, 2015, 48(2): 126-128.
4. Ma ZS, Yang CY, Dong MF, et al. Totally thoracoscopic closure of ventricular septal defect without a robotically assisted surgical system: A summary of 119 cases. J Thorac Cardiovasc Surg, 2014, 147(3): 863-867.
5. Chow SC, Lee AP, Ho AM, et al. Redo tricuspid valve operation in patients with 1 ST-generation mitral prostheses. Asian Cardiovasc Thorac Ann, 2018, 26(7): 524-528.
6. 王崇, 韩林, 陆方林, 等. 再次心脏瓣膜手术 325 例临床分析. 中国胸心血管外科临床杂志, 2013, 20(1): 24-28.
7. Färber G, Tkebuchava S, Dawson RS, et al. Minimally invasive, isolated tricuspid valve redo surgery: A safety and outcome analysis. Thorac Cardiovasc Surg, 2018, 66(7): 564-571.
8. Fatehi Hassanabad A, Turcotte M, Dennehy C, et al. Contemporary reoperative mitral valve surgery: Technical considerations and clinical outcomes. Innovations (Phila), 2020, 15(5): 425-439.
9. Huang LC, Chen DZ, Chen LW, et al. Health-related quality of life following minimally invasive totally endoscopic mitral valve surgery. J Cardiothorac Surg, 2020, 15(1): 194.
10. Kervan U, Cicekcioglu F, Tuluce H, et al. Comparison of neurocognitive functions after beating-heart mitral valve replacement without aorta cross-clamping and after standard mitral valve replacement with cardioplegic arrest. Heart Surg Forum, 2011, 14(6): E335-E339.
11. Pasic M, Sündermann S, Unbehaun A, et al. Beating heart mitral valve surgery: Results in 120 consecutive patients considered unsuitable for conventional mitral valve surgery. Interact Cardiovasc Thorac Surg, 2017, 25(4): 541-547.
12. Peters AC, Unger E, Gong FF, et al. Multimodality imaging to guide transcatheter treatment of severe degenerative tricuspid regurgitation with tricuspid valve-in-ring implantation and paravalvular leak closure. Echocardiography, 2020, 37(6): 913-916.
13. Vallabhajosyula P, Wallen TJ, Solometo LP, et al. Minimally invasive mitral valve surgery utilizing heart port technology. J Card Surg, 2014, 29(3): 343-348.
14. Botta L, Cannata A, Fratto P, et al. The role of the minimally invasive beating heart technique in reoperative valve surgery. J Card Surg, 2012, 27(1): 24-28.
15. 黄焕雷, 柯英杰, 杨亮, 等. 微创成形技术治疗心脏手术后重度三尖瓣关闭不全的中期疗效分析. 中华外科杂志, 2019, 57(12): 902-907.
16. Zhang H, Xu HS, Wen B, et al. Minimally invasive beating heart technique for mitral valve surgery in patients with previous sternotomy and giant left ventricle. J Cardiothorac Surg, 2020, 15(1): 122.
17. Fleißner F, Salman J, Naqizadah J, et al. Minimally invasive surgery in mitral valve endocarditis. Thorac Cardiovasc Surg, 2019, 67(8): 637-643.
18. Xu RB, Rahnavardi M, Nadal M, et al. Beating heart minimally invasive mitral valve surgery in patients with previous sternotomy: The operative technique and early outcomes. Open Heart, 2018, 5(1): e000749.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Minimally invasive cardiac surgery for cardiac atrioventricular valve reoperation

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