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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: ; 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! ... 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... Peripheral canulation • Venous Canulation: one ; two vs multi-stage • Negative pressure Cardioplegia • Custodial – HTK • Warm blood Peripheral Canulation Femoral A – Venous Canulation Internal... Central vs Peripheral canulation • Venous Canulation: ; vs multi-stage • Negative pressure Cardioplegia • Custodial – HTK • Warm blood Myocardial Protection Custodiol HTK Warm blood Thoracotomy with