Left Atrial Dissection During Minimally Invasive Mitral Valve Surgery
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ABSTRACT:
SUBMITTER: Parsons H
PROVIDER: S-EPMC10442375 | biostudies-literature | 2023 Apr
REPOSITORIES: biostudies-literature
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Project description:There is considerable interest and demand in the application of minimally invasive techniques in cardiac surgery driven by multiple factors including patient cosmesis and satisfaction, reduction of surgical trauma and the development of specialized instrumentation that allows these procedures to be performed safely. Minimally invasive mitral valve surgery (MIMVS) has been conducted for more than 25 years and has been shown to offer multiple benefits including better cosmetic results, enhanced post-operative recovery, improved patient satisfaction and most importantly, equivalent clinical outcomes with regards to quality and safety when compared to the standard sternotomy approach. MIMVS may be particularly beneficial in certain subgroups of patients, for example patients undergoing redo mitral valve surgery. In this article, we discuss patient selection criteria for MIMVS, the merits and drawbacks of MIMVS relative to conventional sternotomy approaches, and detail procedural aspects including anaesthetic management, intraoperative technique, and important considerations in myocardial protection and cardiopulmonary bypass (CPB). When considering developing a MIMVS programme, as for any new technique, a team approach to the introduction of the programme is essential. Although it is clear that patient selection is important, particularly early in a surgical programme, with experience complex repairs can be performed through a minimally invasive approach with excellent outcomes.
| S-EPMC8024816 | biostudies-literature
Project description:Left atrial dissection (LatD) is a rare complication of cardiac surgery due to creation of a false chamber through a tear in the mitral valve annulus that extends into the left atrium wall. It is primarily associated with mitral valve surgery although other etiologies have also been defined. Perioperative transesophageal echocardiography (TEE) is a key to the diagnosis. This is a case report of management of LatD after mitral valve replacement.
| S-EPMC6078022 | biostudies-literature
Project description:ObjectivesAlthough clinical experience with transcatheter mitral valve interventions is rapidly increasing, there is still a lack of evidence regarding surgical treatment options for the management of recurrent mitral regurgitation (MR). This study provides guidance for a minimally invasive surgical approach following failed transcatheter mitral valve repair, which is based on the underlying mitral valve (MV) pathology and the type of intervention.MethodsA total of 46 patients who underwent minimally invasive MV surgery due to recurrent or residual MR after transcatheter edge-to-edge repair or direct interventional annuloplasty between October 2014 and March 2021 were included.ResultsThe median age of the patients was 78 [interquartile range, 71-82] years and the EuroSCORE II was 4.41 [interquartile range, 2.66-6.55]. At the index procedure, edge-to-edge repair had been performed in 45 (97.8%) patients and direct annuloplasty in 1 patient. All patients with functional MR at the index procedure (n = 36) underwent MV replacement. Of the patients with degenerative MR (n = 10), 5 patients were eligible for MV repair after removal of the MitraClip. The 1-year survival following surgical treatment was 81.3% and 75.0% in patients with functional and degenerative MR, respectively. No residual MR greater than mild during follow-up was observed in patients who underwent MV repair.ConclusionsMinimally invasive surgery following failed transcatheter mitral valve repair is feasible and safe, with promising midterm survival. The surgical management should be tailored to the underlying valve pathology at the index procedure, the extent of damage of the MV leaflets and the type of previous intervention.
| S-EPMC9270869 | biostudies-literature
Project description: Not available
| S-EPMC10932335 | biostudies-literature
Project description:A 60-year-old man was about to undergo minimally invasive aortic valve replacement when transesophageal echocardiography revealed an intracardiac mass on the left atrial free wall. Multimodal images from 5 months earlier had shown no mass. We converted the procedure to open surgery. The excised mass resembled a cardiac myxoma but was determined to be a papillary fibroelastoma. This case illustrates that papillary fibroelastomas can form and grow rapidly, warranting alertness for their unexpected discovery before and during cardiac surgical procedures.
| S-EPMC9427062 | biostudies-literature
Project description:ObjectivesMinimally invasive mitral valve surgery (MIMVS) has been shown to be safe and feasible however its adoption has lagged globally. The international consortium is lacking a set of guidelines that are specific to MIMVS. The aim of this study was to capture the practices of MIMVS in different centres.MethodsA survey was constructed containing 52 multiple-choice and open-ended questions about various aspects of MIMVS. The survey was sent to centres that routinely and frequently perform MIMVS. All surgeons provided informed consent for participating in the survey and publication of data.ResultsThe survey was sent to 75 known surgeons from whom 32 (42%) completed the survey. All survey responders performed >25 MIMVS cases annually. Twenty (68%) of the surgeons thought that simulation training, MIMVS fellowship and proctorship are all essential prior to commencing an MIMVS program. Eleven (34%) of the surgeons stated that 50-100 MIMVS cases are required to overcome the learning curve, followed by 6 (18%) who said 21-30 cases should suffice. Eighteen (62%) of the surgeons had adopted a fully endoscopic approach for their MIMVS, followed by 15 (51%) surgeons who had performed cases via endoscopic-assisted strategies, 5 (17%) surgeons had conducted the operation under direct visualization and 6 (20%) surgeons had used a robot for their MIMVS.ConclusionsThe study highlights a marked variability on training and approach to MIMVS. Consensus guidelines should be established to allow standardization of MIMVS.
| S-EPMC10550782 | biostudies-literature
Project description:BackgroundRecent trends of surgery for atrial fibrillation (AF) are towards more safe and effective energy sources, as well as to simplified sets of atrial lesions.MethodsOne hundred eighteen (mean age, 67.4 ± 9.2 years) selected patients with paroxysmal/persistent AF and mitral valve (MV) disease underwent cryoablation of AF combined with conventional (not via mini-thoracotomy) MV surgery; the lesion set was limited to only the left atrium. Multivariable analyses identified predictors of cardiac rhythm at hospital discharge and follow-up.ResultsThere were 7 (5.9%) hospital deaths; 33 (28%) patients were discharged on AF. Higher values of preoperative left atrial volume index (odds ratio [OR] = 1.07, 95% confidence interval [95%CI]: 1.01-1.13) and mixed etiology of MV disease (OR = 4.19, 95%CI: 1.23-14.2) were predictors of hospital discharge on AF. Seventy-four (66.7%) patients were on stable sinus rhythm at follow-up (median period, 6.6 years); the 1, 5, and 10-year nonparametric estimates of adjusted freedom from AF were 98.1%, 89.2% and 45.6%, respectively. Higher values of preoperative systolic pulmonary artery pressure (hazard ratio [HR] = HR = 1.04, 95%CI: 1.01-1.08) and AF at hospital discharge (HR = 4.14, 95%CI: 1.50-11.4) were predictors of AF at follow-up.ConclusionsDuring conventional MV surgery, a cryo-lesion set limited to only the left atrium may give good, immediate and long-term results. Left atrial dilation and mixed etiology of MV disease were predictors of hospital discharge on AF. Preoperative pulmonary hypertension and AF at discharge combined with an increased risk of AF at follow-up.
| S-EPMC7575890 | biostudies-literature
Project description:Concomitant LAA occlusion has been shown to be an effective and safe treatment for patients with atrial fibrillation during cardiac surgery to prevent embolic stroke. Minimally invasive procedures are challenging due to restricted access to and visibility of the surgical site. Also, aortic endoclamping has been developed as an alternative surgical approach to exoclamping. The aim of this article is to demonstrate the method of beating heart LAA occlusion with the Atriclip® (AtriCure, Mason, OH, USA) device during minimally invasive mitral valve surgery while using the endoclamping alternative for aortic cross-clamping.
| S-EPMC10573272 | biostudies-literature
Project description:Surgical occlusion of the left atrial appendage (LAA) during cardiac surgery in patients with atrial fibrillation (AF) is known to reduce thromboembolism. However, data on the clinical significance of LAA occlusion (LAAO) in patients with mitral regurgitation (MR) are lacking. A total of 237 AF patients with chronic severe MR who underwent mitral valve (MV) surgery were retrospectively analyzed. Patients were divided into two groups according to concomitant LAAO or LAA preservation. The primary outcome was a composite of all-cause death and thromboembolic events (ischemic stroke or systemic embolism). The LAA was surgically occluded in 98 (41%) patients and preserved in 139 (59%) patients. During the follow-up period (median, 37 months), 29 primary outcomes occurred. In the Kaplan-Meyer analysis, the LAA preservation group showed a greater cumulative incidence of the primary outcome (P = 0.002) and thromboembolic events (P = 0.003) than the LAAO group. In the univariate Cox regression analysis, coronary artery disease, CHA2DS2-VASc score, a cauliflower-shaped LAA, Maze, and no LAAO were significantly associated with the primary outcome. In the multivariate Cox regression analysis, concomitant LAAO was significantly linked to the primary outcome (hazard ratio [HR]: 0.30, 95% confidence interval [CI]: 0.10-0.91, P = 0.033) and thromboembolic events (HR: 0.19, 95% CI: 0.04-0.87, P = 0.032). These benefits from LAAO were consistent, even after propensity score-matched analysis. For patients undergoing surgery for chronic MR who also have AF, concomitant surgical LAAO is associated with favorable clinical outcome.
| S-EPMC11452714 | biostudies-literature
Project description:ObjectiveSurgical closure of the left atrial appendage (LAA) in patients with atrial fibrillation undergoing cardiac surgery can decrease the risk of stroke and thromboembolism and should therefore be considered. In minimally invasive, thoracoscopic, or robotic-assisted mitral valve surgery, however, external procedures such as clip application or epicardial resection are not feasible due to anatomic limitations and the reduced size of the access port. Internal suture closing techniques bear the risk of recurrent LAA reperfusion, so far. We present a novel surgical technique of LAA excision and subsequent defect closure from the interior aspect of the atrium.MethodsWe developed this novel technique during robotic-assisted cardiac surgeries. In short, the LAA is invaginated into the left atrium, excised completely at the base using scissors and the stump is then closed from the inside with a two-layer looped PTFE suture. We give a detailed step-by-step description of the technique.ResultsA total of 20 patients received intra-atrial LAA excision so far. Complete resection of the LAA without any residual stump or bleeding was achieved in all cases. There were no procedure-related complications.ConclusionThe intra-atrial LAA excision technique shows promising preliminary results regarding efficacy, safety, and reproducibility during robotic-assisted cardiac operations and could be recommended for all right-sided minimally invasive cardiac surgical procedures.
| S-EPMC10017964 | biostudies-literature