Minimally-invasive valve surgery in patients with valvular heart disease with comorbidities: A single centre experience

Abstract

Objective: With advancements in technology, instrumentation and techniques in minimally invasive surgery, several new findings have arisen about patients undergoing minimally invasive cardiac valve surgery (MICVS). This study focuses on assessing the safety and effectiveness of MICVS in a particular population, characterized by advanced age, multiple comorbidities and a high-risk profile for conventional open-heart surgery amid scepticism and resistance over minimally invasive cardiac surgery. Methods: This is a descriptive retrospective study. The patients with valvular heart disease having multiple co-morbidities (e.g. left ventricular dysfunction (LVD), elderly, severe pulmonary arterial hypertension (PAH), chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD), obesity, redo surgery etc.) who underwent MICVS between August 2018 to December 2021 at our tertiary cardiac care Institute (UNMICRC)(n=100) were included. Overall, 77 patients underwent minimally invasive mitral/tricuspid valve interventions through right anterolateral mini thoracotomy and 23 patients underwent minimally invasive aortic valve intervention. Various outcomes in terms of patient demographics, intraoperative findings, perioperative data, hospital length of stay, complications were observed and analyzed. Results: Out of 100 patients, 47 were male & 53 were female. The mean age was 43.26 (12.80) years; 13 had infective endocarditis, 11 had previous cardiac intervention, 11 had COPD, 4 had previous history of stroke, 64 patients were diabetic having HbA1C > 7%, 22 patients had severe PAH, 16 - LVD. Nine patients had CKD, among them two patients were on hemodialysis. Average mechanical ventilation time was 9.6 (6.67) hours, average hospital stay was 4.85 (1.05) days and average ICU stay was 56.4 (13.37) hours. Conclusion: In comparison to conventional methods, MICVS appears to have more promising results for this specific patient group, such as fewer postoperative complications, shorter mechanical ventilation time, shorter hospital & ICU stay and a tendency towards quicker recovery. The study highlights the significance of careful patient selection and surgeon experience, as well as the difficulties and complexities of applying MICVS in this specific patient group.

Keywords

• minimal invasive valve surgery
• pulmonary arterial hypertension
• chronic obstructive pulmonary disease
• right anterolateral mini thoracotomy
• thoracotomy