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Tesi etd-05192014-161937


Thesis type
Tesi di laurea specialistica LC6
Author
CANARUTTO, DANIELE
URN
etd-05192014-161937
Title
Early and long-term outcomes of minimally invasive mitral valve surgery through right minithoracotomy: a ten-year experience in 1604 patients
Struttura
RICERCA TRASLAZIONALE E DELLE NUOVE TECNOLOGIE IN MEDICINA E CHIRURGIA
Corso di studi
MEDICINA E CHIRURGIA
Commissione
relatore Dott. Miceli, Antonio
relatore Dott. Glauber, Mattia
Parole chiave
  • minitoracotomia cardiochirurgia cuore mitrale
Data inizio appello
24/06/2014;
Consultabilità
completa
Riassunto analitico
The purpose of this thesis is to report and analyse early and long-term outcomes of all patients that underwent minimally invasive mitral valve surgery through right minithoracotomy at Fondazione Toscana Gabriele Monasterio - Ospedale del Cuore. In September 2003 the first patient was operated on using this technique. At the end of December 2013, a total of 1604 consecutive patients had benefited from minimally invasive mitral valve surgery and thus avoided median sternotomy.<br>The mean age was 63±13 years, 770 (48%) patients were female and 218 (13.6%) had previous cardiac operations. The prevailing etiology was degenerative valve disease (n=1114, 70%), followed by functional mitral regurgitation (n=191, 12%), rheumatic disease (n=151, 9.4%), endocarditis (n=80, 5%) and prosthetic dysfunction (3.2%). Repair rate was 71% overall (n=1137) and even higher (82%, n=932) in the degenerative disease subgroup. Techniques included annuloplasty (95%), leafleat resection (63%), neochordae implantation (16%), and sliding plasty (11%). 476 (29%) patients had their valve replaced. Concomitant procedures included tricuspid valve repair (n=234, 14.6%), atrial fibrillation ablation (n=152, 9.5%) and atrial septal defect closure (n=51, 3.2%). Direct aortic cannulation was achieved in 1289 (80.4%) patients.<br>Overall in-hospital mortality was 1.1% (n=19), lower than predicted by EuroSCORE I (median 6%, interquartile range 3-14%). 34 patients (2.1%) required conversion to standard sternotomy, while 32 (2%) had a stroke. Overall survival at 10 years was 88±2% and freedom from reoperation at 10 years was 91±1% for repair and 82±6% for replacement. Freedom from recurrent mitral regurgitation ≥3+ after 5 years was 94±2%.<br>In summary, minimally invasive mitral valve surgery is safe, reproducible, and associated with low mortality and morbidity, high rate of mitral valve repair and excellent long-term results.<br>
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