Tesi etd-10102019-155523
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Tipo di tesi
Master univ. II liv.
Autore
MARGARYAN, RAFIK
URN
etd-10102019-155523
Titolo
Endoscopic Non Rib Spreading Video Guided Approach To Mitral Valve Surgery: Short and Medium Term Results
Scientific disciplinary sector
SECS-P/08
Corso di studi
Innovation in Cardiac Surgery: Advances in Minimally Invasive Therapeutics
Commissione
Presidente Prof. PASSINO, CLAUDIO
Relatore Dott. SOLINAS, MARCO
Relatore Dott. SOLINAS, MARCO
Parole chiave
- endoscopic mitral surgery
- minimally invasive cardiac surgery
- mitral surgery
Data inizio appello
31/10/2019;
Disponibilità
completa
Riassunto analitico
This thesis summerizes the experience of endoscopic mitral valve surger, as an cutting edge innovative approch to mitral valve surgery.
Objective
Our aim of this thesis was to analyse experience of endoscopic mitral valve surgery in Ospedale Del Cuore in Massa and to determine its non inferiority relative to other minimally invasive mitral valve approaches (inside the same institution).
Material and Methods
312 consecutively operated patients from 2015 to 2019 underwent totally endoscopic mitral valve surgery via limited 3-4 cm right thoracotomy and without costal retractor. All patients had preoperative chest x-ray (antero-posterior and lateral), echocardiogra- phy with quantitative measurments, flow dopplerography for insufiecency estimation. All patients over 40 years old underwent coronarography, only selected patients had computed tomography scan.
Results
Mean age of 62.2 ± 11.8 years old. 97 (31.5%) of the patients were female, mean BMI was 24.7 ± 3.6. Valvular diseases were prevalent degenerative diseases 287 (92%). In men 200 (64.1%) patients a peri-areolar cut was performed. In female, a sub-mammary groove minithoracotomy of about 4 cm (n = 92 (94.8%)) was performed. The average
duration of extra-corporeal circulation was 144.8 ± 30.7 minutes. The aortic clamping on average was 92.3 ± 22.9 minutes. The average mechanical ventilation time was 6.3 ± 3.7 hours. The duration of stay in intensive care units was 1.2 ± 0.7 days.
Conclusion
Endoscopic mitral valve surgery is safe, reproducible and has results excellent potential to become standard of care. It is comparable with minimally invasive mitral valve standard procedures. CPB times and aortic clamping are part of the learning curve but did not a ect the mortality or a ect premature mortality.
Objective
Our aim of this thesis was to analyse experience of endoscopic mitral valve surgery in Ospedale Del Cuore in Massa and to determine its non inferiority relative to other minimally invasive mitral valve approaches (inside the same institution).
Material and Methods
312 consecutively operated patients from 2015 to 2019 underwent totally endoscopic mitral valve surgery via limited 3-4 cm right thoracotomy and without costal retractor. All patients had preoperative chest x-ray (antero-posterior and lateral), echocardiogra- phy with quantitative measurments, flow dopplerography for insufiecency estimation. All patients over 40 years old underwent coronarography, only selected patients had computed tomography scan.
Results
Mean age of 62.2 ± 11.8 years old. 97 (31.5%) of the patients were female, mean BMI was 24.7 ± 3.6. Valvular diseases were prevalent degenerative diseases 287 (92%). In men 200 (64.1%) patients a peri-areolar cut was performed. In female, a sub-mammary groove minithoracotomy of about 4 cm (n = 92 (94.8%)) was performed. The average
duration of extra-corporeal circulation was 144.8 ± 30.7 minutes. The aortic clamping on average was 92.3 ± 22.9 minutes. The average mechanical ventilation time was 6.3 ± 3.7 hours. The duration of stay in intensive care units was 1.2 ± 0.7 days.
Conclusion
Endoscopic mitral valve surgery is safe, reproducible and has results excellent potential to become standard of care. It is comparable with minimally invasive mitral valve standard procedures. CPB times and aortic clamping are part of the learning curve but did not a ect the mortality or a ect premature mortality.
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