PMID- 27543649
OWN - NLM
STAT- MEDLINE
DCOM- 20170830
LR  - 20181202
IS  - 1569-9285 (Electronic)
IS  - 1569-9285 (Linking)
VI  - 23
IP  - 6
DP  - 2016 Dec
TI  - Endoscopic atrioventricular valve surgery in adults with difficult-to-access 
      uncorrected congenital chest wall deformities.
PG  - 851-855
AB  - OBJECTIVES: This study presents the first report on in-hospital and long-term 
      outcomes of endoscopic port access atrioventricular valve surgery (EPAAVVS) in 
      adult patients with uncorrected congenital chest wall deformities (CCWDs). 
      METHODS: Our current surgical team performed EPAAVVS in 7 consecutive adult 
      patients (mean age 51.3 +/- 16.4 years, 14.3% female, 50% older than 60 years, mean 
      EuroSCORE II 0.8 +/- 0.1%) with uncorrected CCWDs between 1 November 2009 and 30 
      November 2015. The mean left ventricular ejection fraction was 66.0 +/- 8.5%. 
      Surgical indications included isolated or combined symptomatic mitral valve (MV) 
      regurgitation (n = 7, 100%), left ventricular outflow tract (LVOT) obstruction (n 
      = 1, 14.3%) and patent foramen ovale (n = 3, 42.9%). Fibro-elastic deficiency 
      accounted for 57.1% of MV pathology and 5 patients (74.1%) presented with New 
      York Heart Association (NYHA) Class III symptoms. CCWDs included isolated pectus 
      excavatum (n = 5, 71.4%) and mixed pectus excavatum and carinatum (n = 2, 28.6%). 
      The mean Haller-index and correction index scores were 2.7 +/- 0.5 and 21.4 +/- 
      10.2%, respectively. RESULTS: Procedures performed included MV repair (n = 7, 
      100%), tricuspid valve (TV) repair (n = 1, 14.3%) and left ventricular septal 
      myomectomy (n = 1, 14.3%). There were no sternotomy conversions or complications 
      with chest wall entry or atrioventricular valve exposure. The mean 
      cardiopulmonary bypass and cross-clamp times were 162.1 +/- 48.1 and 113.7 +/- 33.5 
      min, respectively. No patient required mechanical ventilation or intensive care 
      treatment longer than 24 h. There were no surgical revisions, in-hospital 
      respiratory or chest wall morbidities. The mean length of hospital stay was 7.4 +/- 
      1.0 days. A total of 208 patient-months (mean 29.7 +/- 26.5) were available for 
      long-term clinical and echocardiographic analysis. There were no 30-day or 
      long-term mortalities and no patient required reintervention for residual 
      atrioventricular valve pathology. All patients were classified as NYHA I during 
      recent consultations, and echocardiographic follow-up confirmed no residual MV 
      regurgitation greater than Grade 1 in any patient. CONCLUSIONS: EPAAVVS in adults 
      with uncorrected CCWD is safe, feasible and durable and can successfully be 
      performed by experienced teams to achieve Haller index and correction index 
      scores of up to 3.3 and 38.3%, respectively, with favourable long-term clinical 
      and echocardiographic outcomes. The mere presence of uncorrected CCWDs should not 
      deter surgeons from offering these patients the full benefits of minimally 
      invasive cardiac surgery.
CI  - (c) The Author 2016. Published by Oxford University Press on behalf of the European 
      Association for Cardio-Thoracic Surgery. All rights reserved.
FAU - van der Merwe, Johan
AU  - van der Merwe J
AD  - Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium.
FAU - Casselman, Filip
AU  - Casselman F
AD  - Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium 
      filip.casselman@olvz-aalst.be.
FAU - Stockman, Bernard
AU  - Stockman B
AD  - Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium.
FAU - Vermeulen, Yvette
AU  - Vermeulen Y
AD  - Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium.
FAU - Degrieck, Ivan
AU  - Degrieck I
AD  - Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium.
FAU - Van Praet, Frank
AU  - Van Praet F
AD  - Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium.
LA  - eng
PT  - Journal Article
PT  - Observational Study
DEP - 20160819
PL  - England
TA  - Interact Cardiovasc Thorac Surg
JT  - Interactive cardiovascular and thoracic surgery
JID - 101158399
SB  - IM
MH  - Adult
MH  - Aged
MH  - Cardiopulmonary Bypass
MH  - *Endoscopy
MH  - Female
MH  - Funnel Chest/*complications/surgery
MH  - Humans
MH  - Length of Stay
MH  - Male
MH  - Middle Aged
MH  - Mitral Valve Insufficiency/etiology/*surgery
MH  - Retrospective Studies
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Congenital chest wall deformities
OT  - Minimally invasive cardiac surgery
OT  - Mitral- and tricuspid valve disease
OT  - Outcome
EDAT- 2016/08/21 06:00
MHDA- 2017/08/31 06:00
CRDT- 2016/08/21 06:00
PHST- 2016/02/22 00:00 [received]
PHST- 2016/05/19 00:00 [revised]
PHST- 2016/05/27 00:00 [accepted]
PHST- 2016/08/21 06:00 [pubmed]
PHST- 2017/08/31 06:00 [medline]
PHST- 2016/08/21 06:00 [entrez]
AID - ivw242 [pii]
AID - 10.1093/icvts/ivw242 [doi]
PST - ppublish
SO  - Interact Cardiovasc Thorac Surg. 2016 Dec;23(6):851-855. doi: 
      10.1093/icvts/ivw242. Epub 2016 Aug 19.