Kết quả phẫu thuật tim mạch ít xâm lấn tại viện tim mạch quốc gia việt nam

MITRAL VALVE REPLACEMENT TECHNIQUES
IN MICS APPROACH

Duong Duc Hung, Pham Quoc Dat
Division of Cardiovascular Surgery
Viet Nam National Heart Institute
Bach Mai Hospital


Video assisted MICS


Conventional versus minimally invasive
mitral valve surgery


Minimally invasive mitral valve surgery
Advantage
•
•
•
•
•
•

Less pain
Less scaring
Rapid healing
Avoid sternal wound complication
Less blood loss
Lower LOS

Disadvantage
•
•
•
•

Cost/expensive technology
Limited indication
Ao clamp /CPB time longer
No diffrences in mortality, morbidity,
reoperation, long term survival


OUR APPROACH IN MINIMALLY
INVASIVE CARDIAC SURGERY ?
Advantage

Disadvantage


Strategy in MICS
Patient
Selection

Perfution
strategy

MICS
Techniques

Team
work


Patient Selection

Age < 50
NYHA I-II, EF > 50%

PAPs < 60 mmHg
MV disease
MV replacement

Age < 60
NYHA > II; EF > 30%
PAPs > 60 mmHg
MV disease
MVR/repair

Step by Step

Mitral Valve +
Tricuspid valve

Mitral valve
repair


Perfution Strategy

Canulation
• Central vs Peripheral canulation
• Venous Canulation: one ; two vs multi-stage
• Negative pressure

Cardioplegia
• Custodial – HTK
• Warm blood


Peripheral Canulation
Femoral A – Venous Canulation

Internal jugular vein canulation


Perfution Strategy
Canulation
• Central vs Peripheral canulation
• Venous Canulation: 1 ; 2 vs multi-stage
• Negative pressure

Cardioplegia
• Custodial – HTK
• Warm blood


Myocardial Protection
Custodiol
HTK

Warm
blood


Thoracotomy with mini-incision


Technique in MV replacement


Results
• Total: 24 Patients MVR

• Duration: 1/1/2016-1/10/2016
• Technique success: 100%
• Ao Clamp time: 59,25 ±20,5 mins

• CPB time: 104,75 ± 31,2 mins
• Extubation 1st day: 95,8%
• LOS hospital: 6,7 ± 3,2 days


RESULTS
• Post operative complications:
 Mortality/Morbidity: 0%
 Reoperation: 0%

• Echocardiography
 No residual regurgitation

 Gradient means: 5,6 ±1,2 mmHg



Thank you!