NHI program for introducing thoracoscopic minimally invasive mitral and tricuspid valve surgery

Abstract

In the last decade worldwide and in Egypt, there is an increasing interest and patient demand for minimally invasive cardiac surgery. Methods and results: Since February 12, 2013 till May 9, 2013, six patients underwent thoracoscopic mitral and tricuspid valve surgery (1 tricuspid valve replacement , 1 mitral valve repair, 2 mitral valve replacement , 2 mitral valve replacement and tricsupid repair). Predominant rheumatic in MVR and 1 case was degentrative and the tricuspid case was infective endocarditis. Mean age was 35 years.The procedure was successfully performed in all in the form of 4–5 cm right submammary incision with femoro-femoral canulation for CPB and long shafted instruments with the aid of thoracoscopic view. .Conversion rate to open procedure was (0%). No Hospital mortality was encountered (0%). Mean Bypass time was (90 min) and the cross clamp time was (65 min) .This time is decreasing gradually towards conventional procedure times. Ventilation time was (7 h) and post-operative ICU stay was 3 days, Postoperative morbidity included right phrenic nerve palsy in one patient which recovered after two weeks. Echocardiographic follow-up showed trivial degree of mitral regurgitation (MVP) and well functioning prosthetic valve in the other four. The tricuspid valve showed well-functioning tissue valve with no paravalvular leak (one case) and mild regurge in the repair group (5 patients MVR + TR). All the patients reported mild postoperative pain and felt they had a pleasing scar. All patients were back to work and usual household activities within 4 weeks. Conclusions: Thoracoscopic minimally invasive mitral valve surgery can be performed safely but definitely requires a learning curve. Good results and a high patient satisfaction are guaranteed. We now utilize this approach for isolated atrioventricular valve disease and our plan is to make this exclusive by the end of this year for all the patients except Redo Cases.