SPC365

Introduction of a minimally invasive mitral valve program. A single center analysis.

Session: Sessão de Posters 54 - Intervenção valvular mitral
Speaker: Hagen Kahlbau

Congress: CPC 2024
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 25. Interventional Cardiology
Subtheme: 25.3 Non-coronary Cardiac Intervention
Session Type: Cartazes
FP Number: ---
Authors: Hagen Kahlbau; Pedro Félix; Valdemar Marques Gomes; Luís Miranda; Pedro Coelho
<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:14.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Introduction</span></span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Minimally invasive cardiac surgery (MICS) on the mitral valve (MV) has gained an increasing popularity as it is a completely sternum sparing surgery, maintaining however all the advantages of a surgical procedure, in particular the MV repair. The objective of this study is to analyze short term outcomes of patients undergoing a MICS valve program introduced in 2023.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:14.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Material and Methods</span></span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Knowledge and technical expertise in MICS was acquired in a tertiary hospital center in Switzerland over a course of six months and through accredited practical hands on courses.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Contraindications were severe left ventricular dilatation, significant aortic insufficiency, ascending aortic aneurysms, active endocarditis, difficult peripheral vessel access and deformities of the thorax. A total of 20 patients were operated through a minimally invasive access (pre-operative characteristics table 1).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:14.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Results</span></span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Operative results are described in table 2. The repair rate in the mitral regurgitation (MR) group was 94,5%. In 3 patients atrial fibrillation ablation (crioablation) was performed and in 10 patients the left atrial appendage closure. In 2 patients an unsatisfactory result on transesophagic echocardiography could be adequately corrected in a second cross clamp time. In one patient&nbsp;&nbsp; occurred a bleeding complication of the pulmonary artery and had to be converted to full sternotomy. There was no intraoperative mortality. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Postoperative characteristics are shown in table 3. Mean time of ventilation was 6,3 hours, mean total hemorrhage 790 ml with necessity of in mean one blood transfusion in 30%. There were no cerebrovascular events or renal complications. In one patient a permanent Pacemaker implantation was necessary. Mean ICU stay was 2 days and mean hospital stay 6 days. Pre-discharge echocardiography showed no residual MR in 10 patients (50%), mild MR in 10 patients (50%), and no moderate or severe MR. There was no mortality at 30 days.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:14.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Discussion</span></span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Continuous training of the surgical team during at least six months in a reference center is of crucial importance for a successful initiation of a MICS MV program. As our results of the initial 20 patients clearly underline the non-inferiority described in the literature, we would in the next phase of our program include patients with mitral and tricuspid pathologies. All patients in our group had good surgical outcome with no moderate or severe MR at discharge and no major cardiac, renal or cerebrovascular events.</span></span></span></span></p>