PMID- 18442536
OWN - NLM
STAT- MEDLINE
DCOM- 20080515
LR  - 20141120
IS  - 1552-6259 (Electronic)
IS  - 0003-4975 (Linking)
VI  - 85
IP  - 5
DP  - 2008 May
TI  - Less invasive intracardiac surgery performed without aortic clamping.
PG  - 1551-5
LID - 10.1016/j.athoracsur.2008.01.071 [doi]
AB  - BACKGROUND: Aortic clamping and cardioplegia delivery add complexity to 
      performing intracardiac procedures through a right minithoracotomy. Recent 
      publications have shown excellent patient outcomes after mitral valve (MV) 
      procedures undertaken through thoracotomy on the fibrillating heart. We reviewed 
      our experience with this approach. METHODS: From March 2000 to September 2006, 
      100 patients underwent MV repair (n = 42), MV annuloplasty (n = 28), MV 
      replacement (n = 18), atrial septal defect closure (n = 10), tricuspid valve 
      repair (n = 1), and left atrial myxoma excision (n = 1). A modified maze 
      procedure (n = 4) or left minimally invasive direct coronary bypass grafting 
      (MIDCABG) (n = 2) was combined in six cases. The mean age was 57 +/- 11 years 
      (range, 22 to 89); 27 patients were in New York Heart Association (NYHA) class 
      III or IV; 24 cases were first or second time reoperations; 20 patients had a 
      left ventricular ejection fraction of less than 0.3. All the operations were 
      carried out on the fibrillating heart without cross-clamping the aorta through a 
      right minithoracotomy using peripheral cannulation. RESULTS: Mean fibrillation 
      time was 73 +/- 31 minutes (range, 10 to 198 minutes). There was no conversion to 
      sternotomy. Postoperative inotropic support was needed in 20 cases. One patient 
      who underwent a third time reoperation died within 30 days of mesenteric ischemia 
      (hospital mortality = 1%). Complications were the following: four reoperations 
      for bleeding (4%); two strokes (2%). Postoperative median hospital length of stay 
      was five days (range, 2 to 58 days). None of the patients has required MV 
      reoperation after hospital discharge. Follow-up was complete. All survivors were 
      in NYHA class I or II. CONCLUSIONS: Ventricular fibrillation simplifies less 
      invasive intracardiac procedures and carries lower complication rates and 
      perioperative mortality compared with conventional surgery.
FAU - Loulmet, Didier F
AU  - Loulmet DF
AD  - Department of Cardiothoracic Surgery, Lenox Hill Hospital, New York, New York 
      10075, USA. loulmetd@aol.com
FAU - Patel, Nirav C
AU  - Patel NC
FAU - Jennings, Joan M
AU  - Jennings JM
FAU - Subramanian, Valavanur A
AU  - Subramanian VA
LA  - eng
PT  - Journal Article
PL  - Netherlands
TA  - Ann Thorac Surg
JT  - The Annals of thoracic surgery
JID - 15030100R
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Cardiac Pacing, Artificial
MH  - Coronary Artery Bypass
MH  - Female
MH  - Heart Atria/surgery
MH  - Heart Diseases/*surgery
MH  - Heart Neoplasms/surgery
MH  - Heart Septal Defects, Atrial/surgery
MH  - Heart Valve Diseases/*surgery
MH  - Heart Valve Prosthesis Implantation
MH  - Hospital Mortality
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - *Minimally Invasive Surgical Procedures
MH  - Mitral Valve/surgery
MH  - Myxoma/surgery
MH  - Postoperative Complications/mortality/surgery
MH  - Reoperation
MH  - *Thoracotomy
MH  - Tricuspid Valve/surgery
MH  - Ventricular Fibrillation/*physiopathology
EDAT- 2008/04/30 09:00
MHDA- 2008/05/16 09:00
CRDT- 2008/04/30 09:00
PHST- 2007/02/01 00:00 [received]
PHST- 2008/01/22 00:00 [revised]
PHST- 2008/01/23 00:00 [accepted]
PHST- 2008/04/30 09:00 [pubmed]
PHST- 2008/05/16 09:00 [medline]
PHST- 2008/04/30 09:00 [entrez]
AID - S0003-4975(08)00212-9 [pii]
AID - 10.1016/j.athoracsur.2008.01.071 [doi]
PST - ppublish
SO  - Ann Thorac Surg. 2008 May;85(5):1551-5. doi: 10.1016/j.athoracsur.2008.01.071.