MO07. Totally Endoscopic Minimally Invasive Mitral Valvuloplasty with Beating Heart for Treatment of Acute Myocardial Infarction Complicated with Papillary Muscle Rupture
Presented During: Breakfast Abstract Video Session
Southern Medical University
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Name: Huan-lei Huang
Title: Cardiac Surgeon; Professor in Cardiovascular Surgery; Head, Department of Cardiac Valve Surgery and Minimally Invasive Cardiac Surgery
Dr. Huang studied medicine in Gannan Medical College in Jiangxi Province, China. In 1998, he completed his surgical residence program at the First Affiliated Hospital of Gannan Medical College. In 2002, he completed his cardiac surgery training at Department of Cardiovascular Surgery, Guangdong Provincial People’s Hospital, Guangdong Provincial Cardiovascular Institute in Guangzhou. He was working in University of Rochester Medical Center in USA as visiting scholar from Nov 2004 to Nov 2005. He is the member of International Society for Minimally Invasive Cardiothoracic Surgery (ISMICS), and the member of the Society of Cardiothoracic Surgery, Chinese Medical Association.
Research Interests: Dr. Huang’s expertise is in minimally invasive cardiac surgery and surgical treatment of end-stage heart failure. He performed the first minimally invasive valve surgery from ministernotomy in 2007 (aortic), the first totally endoscopic mitral valve repair in 2012, and the first totally endoscopic mitral valve re-replacement on beating-heart in 2015. In the past several years, he performed totally endoscopic cardiac surgery up to 300 cases per year, including at least 100 cases of totally endoscopic mitral valve repair. He developed a new operation for patients with severe tricuspid regurgitation following cardiac surgery, with decreasing mortality of surgery. His paper entitled “A novel beating-heart totally endoscopic tricuspid valvuloplasty technique with patch augmentation in reoperative cardiac surgery” was accepted for presentation at the AATS 98th annual meeting, April 28 – May 1, 2018, San Diego, CA, and paper entitled “Outcomes of beating-heart totally endoscopic tricuspid valvuloplasty in reoperative cardiac surgery” was accepted for presentation at the 2019 Annual Scientific Meeting of International Societ
Friday, May 5, 2023: 7:48 AM - 7:56 AM
8 Minutes
New York Hilton Midtown
Room: Grand Ballroom
Description
Objective: Papillary muscle rupture after coronary stent implantation in acute myocardial infarction is a life-threatening complication. Totally endoscopic minimally invasive mitral valvuloplasty (TEMI-MVP)with beating heart is a viable and effective option.
Case Video Summary: A male Patient(64y) was emergently transferred to our hospital with the support of IABP and ECMO, who underwent stent implantation 3 days ago for acute total occlusion of right coronary. Echocardiography showed severe mitral regurgitation with posterior leaflet flail associated with a highly mobile mass representing ruptured papillary muscle head. TEMI-MVP on beating heart was performed. Cardiopulmonary bypass(CPB) was established with previous cannulations of the femoral artery and vein of ECMO, and ECMO system maintained a self-circulation. The minimally invasive approach was adopted, thoracic cavity was flushed continuously by CO2. Excellent mitral valve exposure could be obtained through the incision of the interatrial groove with left atrial retractor. Intraoperative exploration revealed rupture of the complete posteromedial papillary muscle, and posterior leaflet prolapse. Ruptured papillary muscle heads was removed, and two groups of artificial chordae were anchored using 5-0 ePTFE suture; the posterior internal commissure was closed by continuous suture using 5-0 suture and strengthened by two pledgetted mattress sutures; finally, 28# annuloplasty full ring was implanted. Saline injection test showed good function of mitral valve, then the left atrial was closed. Left ventricular drainage tube was not removed for decompression, and the other end of the tube was connected to the cannulation of femoral vein through the chest wall via the major operating port. Postoperative transesophageal echocardiography (TEE) showed trivial regurgitation, the mean mitral valve pressure gradient was 4mmHg. CPB was weaned off smoothly, the cannulations of femoral artery and vein were reconnected to ECMO. The patient was conscious on postoperative day 2, weaned from ECMO, IABP, and ventilator on postoperative day 5, 7, 21, respectively.
Conclusions: For the patients in the early stage of coronary stent implantation for acute myocardial infarction complicated with papillary muscle rupture, beating heart technique was helpful to reduce myocardial injury. Minimally invasive mitral valve repair could improve surgery outcomes. However, pulmonary edema had adverse effect on surgical vision.
Case Video Summary: A male Patient(64y) was emergently transferred to our hospital with the support of IABP and ECMO, who underwent stent implantation 3 days ago for acute total occlusion of right coronary. Echocardiography showed severe mitral regurgitation with posterior leaflet flail associated with a highly mobile mass representing ruptured papillary muscle head. TEMI-MVP on beating heart was performed. Cardiopulmonary bypass(CPB) was established with previous cannulations of the femoral artery and vein of ECMO, and ECMO system maintained a self-circulation. The minimally invasive approach was adopted, thoracic cavity was flushed continuously by CO2. Excellent mitral valve exposure could be obtained through the incision of the interatrial groove with left atrial retractor. Intraoperative exploration revealed rupture of the complete posteromedial papillary muscle, and posterior leaflet prolapse. Ruptured papillary muscle heads was removed, and two groups of artificial chordae were anchored using 5-0 ePTFE suture; the posterior internal commissure was closed by continuous suture using 5-0 suture and strengthened by two pledgetted mattress sutures; finally, 28# annuloplasty full ring was implanted. Saline injection test showed good function of mitral valve, then the left atrial was closed. Left ventricular drainage tube was not removed for decompression, and the other end of the tube was connected to the cannulation of femoral vein through the chest wall via the major operating port. Postoperative transesophageal echocardiography (TEE) showed trivial regurgitation, the mean mitral valve pressure gradient was 4mmHg. CPB was weaned off smoothly, the cannulations of femoral artery and vein were reconnected to ECMO. The patient was conscious on postoperative day 2, weaned from ECMO, IABP, and ventilator on postoperative day 5, 7, 21, respectively.
Conclusions: For the patients in the early stage of coronary stent implantation for acute myocardial infarction complicated with papillary muscle rupture, beating heart technique was helpful to reduce myocardial injury. Minimally invasive mitral valve repair could improve surgery outcomes. However, pulmonary edema had adverse effect on surgical vision.
Presentation Duration
5-minute presentation; 3-minute discussion