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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