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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 assis

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!