Mitral valve replacement techniques in MICS approach

Minimally invasive mitral valve surgery

Advantage

• Less pain

• Less scaring

• Rapid healing

• Avoid sternal wound complication

• Less blood loss

• Lower LOS

Disadvantage

• Cost/expensive technology

• Limited indication

• Ao clamp /CPB time longer

• No diffrences in mortality, morbidity,

reoperation, long term survival

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MITRAL VALVE REPLACEMENT TECHNIQUES 
IN MICS APPROACH 
Duong Duc Hung, Pham Quoc Dat 
 Division of Cardiovascular Surgery 
 Viet Nam National Heart Institute 
 Bach Mai Hospital 
Video assisted MICS 
Conventional versus minimally invasive 
mitral valve surgery 
Minimally invasive mitral valve surgery 
Advantage 
• Less pain 
• Less scaring 
• Rapid healing 
• Avoid sternal wound complication 
• Less blood loss 
• Lower LOS 
Disadvantage 
• Cost/expensive technology 
• Limited indication 
• Ao clamp /CPB time longer 
• No diffrences in mortality, morbidity, 
reoperation, long term survival 
 OUR APPROACH IN MINIMALLY 
INVASIVE CARDIAC SURGERY ? 
Advantage 
Disadvantage 
Strategy in MICS 
MICS 
Patient 
Selection 
Team 
work 
Techniques 
Perfution 
strategy 
Patient Selection 
Age < 50 
NYHA I-II, EF > 50% 
PAPs < 60 mmHg 
MV disease 
MV replacement 
Age < 60 
NYHA > II; EF > 30% 
PAPs > 60 mmHg 
MV disease 
MVR/repair 
Mitral Valve + 
Tricuspid valve 
Mitral valve 
repair 
Step by Step 
Perfution Strategy 
Canulation 
• Central vs Peripheral canulation 
• Venous Canulation: one ; two vs multi-stage 
• Negative pressure 
Cardioplegia 
•Custodial – HTK 
•Warm blood 
Peripheral Canulation 
Femoral A – Venous Canulation Internal jugular vein canulation 
Perfution Strategy 
Canulation 
• Central vs Peripheral canulation 
• Venous Canulation: 1 ; 2 vs multi-stage 
• Negative pressure 
Cardioplegia 
•Custodial – HTK 
•Warm blood 
Myocardial Protection 
Custodiol 
HTK 
Warm 
blood 
Thoracotomy with mini-incision 
Technique in MV replacement 
Results 
• Total: 24 Patients MVR 
• Duration: 1/1/2016-1/10/2016 
• Technique success: 100% 
• Ao Clamp time: 59,25 ±20,5 mins 
• CPB time: 104,75 ± 31,2 mins 
• Extubation 1st day: 95,8% 
• LOS hospital: 6,7 ± 3,2 days 
RESULTS 
• Post operative complications: 
 Mortality/Morbidity: 0% 
 Reoperation: 0% 
• Echocardiography 
 No residual regurgitation 
 Gradient means: 5,6 ±1,2 mmHg 
Thank you! 

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