Minimally Invasive Mitral Valve Surgery Using a Cold Fibrillatory Cardiac Arrest Technique in Patients With Prior Cardiac Surgery.

IF 0.9 4区 医学 Texas Heart Institute Journal Pub Date : 2024-07-19 DOI:10.14503/THIJ-23-8167
Ahmed Ali, Zachary Gray, Gabriel Loor, Alexis E Shafii, Todd K Rosengart, Kenneth K Liao
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Abstract

Objective: Minimally invasive mitral valve surgery (mini-MVS) is typically reserved for patients who have not undergone open cardiac surgery. In the reoperative setting, using intrapericardial dissection for crossclamping the aorta through a minimally invasive approach can be difficult and, at times, risky. Cold fibrillatory cardiac arrest (CFCA) with systemic cardiopulmonary bypass without cross-clamping is a well-described technique; however, data about its safety for patients who undergo reoperative mini-MVS are limited.

Methods: Data for 34 patients who underwent reoperative mini-MVS with CFCA from March 2017 to March 2022 were reviewed retrospectively. A mini right thoracotomy (n = 30) or robotic (n = 4) approach was used. Systemic hypothermia was induced to a target temperature of 25 °C.

Results: Patient mean (SD) age was 64.5 (9.6) years, and 15 of 34 (44.1%) patients were women. Of those 34 patients, 23 (67.6%) had severe regurgitation, and 11 (32.4%) had severe stenosis. Before mini-MVS, 28 patients had undergone valve surgery, and 8 had undergone coronary artery bypass graft surgery. The mitral valve was repaired in 5 of 34 (14.7%) and replaced in 29 of 34 (85.3%) patients. No difference was observed in preoperative and postoperative left ventricular function (P = .82). In 1 patient, kidney failure developed that necessitated dialysis. No postoperative stroke or mortality at 30 days occurred.

Conclusion: Mini-MVS with CFCA is well tolerated in patients with prior cardiac surgery. Myocardial function was not impaired, nor was the risk of stroke increased in this cohort, indicating that CFCA is a safe alternative in this high-risk population.

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在接受过心脏手术的患者中使用冷颤性心脏停搏技术进行二尖瓣微创手术
目的:微创二尖瓣手术(mini-MVS)通常只适用于未接受过心脏开放手术的患者。在再次手术的情况下,通过微创方法使用心包内剥离术横断主动脉可能会很困难,有时还会有风险。冷纤颤性心脏停搏(CFCA)配合全身心肺旁路而不进行横切是一种描述详尽的技术;然而,有关其对接受再手术微型心血管系统患者安全性的数据却很有限:方法:回顾性分析了2017年3月至2022年3月期间34名接受CFCA再手术迷你MVS患者的数据。采用迷你右胸廓切开术(n = 30)或机器人(n = 4)方法。全身低温诱导至目标温度25 °C:患者平均(标清)年龄为 64.5(9.6)岁,34 名患者中有 15 名(44.1%)为女性。在这 34 名患者中,23 人(67.6%)有严重的反流,11 人(32.4%)有严重的狭窄。在进行 mini-MVS 之前,28 名患者接受过瓣膜手术,8 名患者接受过冠状动脉旁路移植手术。34 位患者中有 5 位(14.7%)接受了二尖瓣修复手术,34 位患者中有 29 位(85.3%)接受了二尖瓣置换手术。术前和术后左心室功能无差异(P = .82)。一名患者出现肾衰竭,需要进行透析。术后 30 天未发生中风或死亡:结论:曾接受过心脏手术的患者对使用 CFCA 的 Mini-MVS 耐受良好。该组患者的心肌功能未受损,中风风险也未增加,这表明 CFCA 是此类高危人群的安全替代选择。
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来源期刊
Texas Heart Institute Journal
Texas Heart Institute Journal CARDIAC & CARDIOVASCULAR SYSTEMS-
自引率
11.10%
发文量
131
期刊介绍: For more than 45 years, the Texas Heart Institute Journal has been published by the Texas Heart Institute as part of its medical education program. Our bimonthly peer-reviewed journal enjoys a global audience of physicians, scientists, and healthcare professionals who are contributing to the prevention, diagnosis, and treatment of cardiovascular disease. The Journal was printed under the name of Cardiovascular Diseases from 1974 through 1981 (ISSN 0093-3546). The name was changed to Texas Heart Institute Journal in 1982 and was printed through 2013 (ISSN 0730-2347). In 2014, the Journal moved to online-only publication. It is indexed by Index Medicus/MEDLINE and by other indexing and abstracting services worldwide. Our full archive is available at PubMed Central. The Journal invites authors to submit these article types for review: -Clinical Investigations- Laboratory Investigations- Reviews- Techniques- Coronary Anomalies- History of Medicine- Case Reports/Case Series (Submission Fee: $70.00 USD)- Images in Cardiovascular Medicine (Submission Fee: $35.00 USD)- Guest Editorials- Peabody’s Corner- Letters to the Editor
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