MP04. Antero-lateral Mini-thoracotomy Approach for Both Mitral and Aortic Valve Surgery with Direct Vision: "Miami Method"
Sisli Kolan International Hospital
Istanbul
Turkey - Contact Me
Professor Ergun Demirsoy was born on February 7th, 1965. He received his cardiovascular surgery degree in 1995. He is currently working as the Chief of the Cardiovascular Surgery Department at Şişli Kolan International Hospital in Istanbul, Turkey. His expertise lies in performing minimally invasive coronary bypass surgery and minimally invasive valve surgery, including mitral valve repair. Throughout his career, he has also gained significant experience at OLV Clinic in Aalst-Belgium, Geneva University Hospital in Switzerland, and Loyola University Hospital in Chicago-USA. Additionally, he is an active member of the European Society for Cardiovascular and Endovascular Surgery, holding the title of President Elect in the executive committee.
Description
In recent years, various minimally invasive approaches have gained increasing recognition as an alternative to traditional median sternotomy in valve surgery and it can be regarded as an option to catheter-based interventions. Here, we aim to describe our experience with a modified technique called the "Miami Method," which involves a right mid-axillary anterolateral mini-thoracotomy.
Methods:
We conducted a clinical study on 25 patients, 15 of whom were male, with an average age of 59.2±15.4 (range 25-87). The study took place from October 2021 to December 2022, and all surgeries were performed using a 3rd or 4th right mid-axillary curved vertical incision with direct visualization.
Results:
Of the 25 patients, 5 received aortic valve replacement, 12 received mitral valve replacement or repair with additional tricuspid valve repair if needed, 1 received combined aortic and mitral valve replacement, 3 underwent tricuspid surgery only, 2 underwent combined mitral valve repair and CABG, 2 were operated on for sinus venosum defect and partial anomalous pulmonary venous return, and 3 received additional ablation procedures for AF. Of the 5 patients who had previously undergone surgery, 3 were operated with CPB support without cross-clamping.
The average cross-clamp time was 114±35 (range 67-207) minutes, and the total bypass time was 175±47 (range 119-299) minutes. There were no deaths, but one patient required revision surgery due to bleeding and one patient experienced a transient stroke that resolved without long-term effects.
Conclusions:
We believe that this surgical method, which allows for direct visualization, can be safely and successfully performed on high-risk patients and is suitable for performing complex mitral repair as well as aortic valve replacement.