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Joseph Lamelas - One of the best experts on this subject based on the ideXlab platform.
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outcomes of reoperative aortic valve replacement via right mini thoracotomy versus median Sternotomy
Journal of Heart Valve Disease, 2013Co-Authors: Andres M Pineda, Orlando Santana, Javier Reyna, Alejandro Sarria, Gervasio A Lamas, Joseph LamelasAbstract:Background and aim of the study: The study aim was to determine the safety and efficacy of a minimally invasive right mini-thoracotomy for aortic valve replacement (AVR) in patients who had undergone previous median Sternotomy. Methods: Between January 2005 and December 2011, a total of 3,603 consecutive cases was retrospectively reviewed to identify patients with previous median Sternotomy who subsequently underwent AVR. The outcomes of patients having minimally invasive surgery were compared with those in whom a median Sternotomy approach had been employed. Results: Among 77 patients identified, 36 (47%) underwent a minimally invasive approach, and 41 (53%) had a median Sternotomy. The mean age of the minimally invasive group (33 males, three females) was 75.3 ± 9.0 years, and that of the median Sternotomy group (33 males, eight females) was 68.2 ± 13.6 years (p = 0.009). The minimally invasive group had more prior Sternotomy for coronary artery bypass graft surgery (86% versus 59%, p = 0.007), and fewer for prior valve surgery (33% versus 59%, p = 0.02). In-hospital mortality was zero for the minimally invasive cohort versus four (10%) in the median Sternotomy group (p = 0.08); composite postoperative complications occurred in six (17%) versus 19 (46%) (p = 0.005) of these two groups, respectively. The median intensive care unit and total hospital length of stay were 48 h [interquartile range (IQR) 41-97] versus 69 h [IQR 45-174] (p = 0.03), and seven days [IQR 5-10] versus 9 days [IQR 7-15] (p = 0.03) for the minimally invasive and median Sternotomy group, respectively. Conclusion: Minimally invasive AVR via a right mini-thoracotomy in patients with previous cardiac surgery can be performed safely, and is associated with shorter intensive care unit and total hospital stays, a lower morbidity, and a trend towards lower mortality.
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outcomes of minimally invasive valve surgery in patients with chronic obstructive pulmonary disease
European Journal of Cardio-Thoracic Surgery, 2012Co-Authors: Orlando Santana, Javier Reyna, Gervasio A Lamas, Alexandre M Benjo, Joseph LamelasAbstract:OBJECTIVES: We hypothesize that minimally invasive valve surgery in patients with chronic obstructive pulmonary disease (COPD) is superior to the conventional median Sternotomy approach. METHODS: We retrospectively reviewed 2846 consecutive surgery performed at our institution between January 2005 and September 2010, and identified 165 patients with COPD who underwent isolated valve surgery. In-hospital mortality, composite complication rates, intensive care unit and total hospital length of stay of those who had undergone a minimally invasive approach were compared with a cohort that underwent a standard median Sternotomy approach. RESULTS: Of the 165 patients, 100 underwent a minimally invasive approach and 65 had a median Sternotomy. Baseline characteristics did not differ between the two groups. The mean age was 71±11 years for the minimally invasive group and 68±12 years for the median Sternotomy group, (P=0.31). In-hospital mortality was 1 (1%) in the minimally invasive group and 3 (5%) in the median Sternotomy group, P=0.14. Composite postoperative complications were significantly reduced in the minimally invasive group (30 versus 54%, P=0.002). The median intensive care unit length of stay was 47 h (IQR 40–70) versus 73 h (IQR 51–112), P<0.001, and the median postoperative length of stay was 6 days (IQR 5–9) versus 9 days (IQR 7–13), P<0.001, for the minimally invasive and the median Sternotomy groups, respectively. CONCLUSIONS: Minimally invasive valve surgery in patients with COPD is associated with excellent short-term results, and thus should be considered an option in these patients.
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outcomes of a minimally invasive approach compared with median Sternotomy for the excision of benign cardiac masses
The Annals of Thoracic Surgery, 2011Co-Authors: Andres M Pineda, Orlando Santana, Gervasio A Lamas, Alexandre M Benjo, Carlos Zamora, Joseph LamelasAbstract:Background We hypothesize that for the excision of benign cardiac masses, a minimally invasive approach through a right minithoracotomy is safe and feasible, and has lower resource utilization when compared with a standard median Sternotomy. Methods We retrospectively analyzed 39 consecutive patients who underwent benign cardiac mass excision at our institution between December 1999 and April 2010. The in-hospital outcomes of patients who had a right minithoracotomy were compared with those of patients who underwent a standard median Sternotomy. Results Of the 39 patients, 22 had cardiac masses removed through a minimally invasive approach, and 17 had a median Sternotomy. The type of masses resected included 26 myxomas (66.7%), 9 papillary fibroelastomas (23.1%), and 4 thrombi (10.2%). The aortic cross-clamp and cardiopulmonary bypass times were 43 minutes (interquartile range [IQR] 30 to 64) versus 31 minutes (IQR 23 to 47; p = 0.20) and 78 minutes (IQR 55 to 88) versus 57 minutes (IQR 33 to 70; p = 0.02) for the minimally invasive group and the median Sternotomy group, respectively. There were no significant differences in postoperative complications including mortality. The mean intensive care unit and hospital lengths of stay were 27 hours (IQR 24 to 47) versus 60 hours (IQR 48 to 79; p = 0.001) and 5 days (IQR 4 to 6) versus 7 days (IQR 6 to 8; p = 0.03) for the minimally invasive and the median Sternotomy group, respectively. Conclusions A minimally invasive approach through a right minithoracotomy for the resection of benign cardiac masses can be performed safely with lower resource utilization, and should be considered for these patients.
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outcomes of minimally invasive valve surgery versus standard Sternotomy in obese patients undergoing isolated valve surgery
The Annals of Thoracic Surgery, 2011Co-Authors: Orlando Santana, Javier Reyna, Gervasio A Lamas, Robert Grana, Mauricio Buendia, Joseph LamelasAbstract:Background We hypothesize that composite in-hospital surgical complications are lower in obese patients who undergo minimally invasive valve surgery for aortic and (or) mitral valve disease, when compared with the standard median Sternotomy approach. Methods We retrospectively reviewed 2,288 heart operations done at our institution between January 3, 2005 and January 10, 2010, and identified 160 consecutive obese patients, defined as patients with a body mass index of greater than 30 kg/m 2 , who underwent isolated mitral and (or) aortic valve surgery. The outcomes of those who had minimally invasive valve surgery were compared with a matched control group who had valve surgery through a median Sternotomy approach. Results Of the 160 patients, 64 underwent the minimally invasive approach and 96 had a median Sternotomy. The mean age was 69.4 ± 11 years for the minimally invasive group, and 64.7 ± 11.5 for the median Sternotomy group ( p = 0.015). Composite postoperative complications occurred in 15 (23.49%) versus 49 (51.0%) patients ( p = 0.034) in the minimally invasive group versus median Sternotomy, respectively. The difference was driven by a lower incidence of acute renal failure (0 vs 6 patients [6.25%], p = 0.041), prolonged intubation (12 [18.7%] vs 33 [34.3%], p = 0.049), reintubation (3 [4.68%] vs 15 [15.6%], p = 0.032), deep wound infections (0 vs 4 [4.1%], p = 0.098), and death (0 vs 8 [8.3%], p = 0.041), respectively. All patients in the minimally invasive group were alive at 30 days. Conclusions Minimally invasive surgery for isolated valve lesions in obese patients has a lower morbidity and mortality when compared with the standard median Sternotomy approach.
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outcomes of minimally invasive valve surgery versus median Sternotomy in patients age 75 years or greater
The Annals of Thoracic Surgery, 2011Co-Authors: Joseph Lamelas, Andres M Pineda, Orlando Santana, Alejandro Sarria, Gervasio A LamasAbstract:Background Advanced age is a major predictor of poor outcome in patients undergoing valve surgery. We hypothesized that elderly patients who underwent minimally invasive valve surgery for aortic or mitral valve disease would do better when compared with those undergoing the standard median Sternotomy. Methods We retrospectively reviewed 2,107 consecutive heart operations at our institution and identified 203 patients, age 75 years or greater, who underwent isolated mitral or aortic valve surgery. Outcomes of those who had minimally invasive valve surgery through a right minithoracotomy were compared with those who had a median Sternotomy. Results Of the 203 patients, 119 (59%) underwent a minimally invasive approach, while 84 (41%) had a median Sternotomy. The median postoperative length of stay was 7 days (interquartile range [IQR] 6 to 10) versus 12 days (IQR 9 to 20), p less than 0.001, and intensive care unit length of stay was 52 hours (IQR 44 to 93) versus 119 hours (IQR 57 to 193), p less than 0.001 for minimally invasive and median Sternotomy, respectively. In-hospital mortality was 2 (1.7%) versus 8 (9.5%, p=0.01 and composite postoperative morbidity and mortality occurred in 25 (21%) versus 38 (45.2%), p less than 0.001, in minimally invasive versus median Sternotomy, respectively. The difference was driven by the following: a lower incidence of acute renal failure, 1 (0.8%) versus 14 (16.7%), p less than 0.001; prolonged intubation 23 (19.3%) versus 32 (38.1%), p=0.003; wound infections 1 (0.8%) versus 5 (6%), p=0.034; and death. Conclusions Minimally invasive surgery for isolated valve lesions in elderly patients yields a lower morbidity and mortality when compared with median Sternotomy and should be considered when such individuals require valve surgery.
Gervasio A Lamas - One of the best experts on this subject based on the ideXlab platform.
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outcomes of reoperative aortic valve replacement via right mini thoracotomy versus median Sternotomy
Journal of Heart Valve Disease, 2013Co-Authors: Andres M Pineda, Orlando Santana, Javier Reyna, Alejandro Sarria, Gervasio A Lamas, Joseph LamelasAbstract:Background and aim of the study: The study aim was to determine the safety and efficacy of a minimally invasive right mini-thoracotomy for aortic valve replacement (AVR) in patients who had undergone previous median Sternotomy. Methods: Between January 2005 and December 2011, a total of 3,603 consecutive cases was retrospectively reviewed to identify patients with previous median Sternotomy who subsequently underwent AVR. The outcomes of patients having minimally invasive surgery were compared with those in whom a median Sternotomy approach had been employed. Results: Among 77 patients identified, 36 (47%) underwent a minimally invasive approach, and 41 (53%) had a median Sternotomy. The mean age of the minimally invasive group (33 males, three females) was 75.3 ± 9.0 years, and that of the median Sternotomy group (33 males, eight females) was 68.2 ± 13.6 years (p = 0.009). The minimally invasive group had more prior Sternotomy for coronary artery bypass graft surgery (86% versus 59%, p = 0.007), and fewer for prior valve surgery (33% versus 59%, p = 0.02). In-hospital mortality was zero for the minimally invasive cohort versus four (10%) in the median Sternotomy group (p = 0.08); composite postoperative complications occurred in six (17%) versus 19 (46%) (p = 0.005) of these two groups, respectively. The median intensive care unit and total hospital length of stay were 48 h [interquartile range (IQR) 41-97] versus 69 h [IQR 45-174] (p = 0.03), and seven days [IQR 5-10] versus 9 days [IQR 7-15] (p = 0.03) for the minimally invasive and median Sternotomy group, respectively. Conclusion: Minimally invasive AVR via a right mini-thoracotomy in patients with previous cardiac surgery can be performed safely, and is associated with shorter intensive care unit and total hospital stays, a lower morbidity, and a trend towards lower mortality.
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outcomes of minimally invasive valve surgery in patients with chronic obstructive pulmonary disease
European Journal of Cardio-Thoracic Surgery, 2012Co-Authors: Orlando Santana, Javier Reyna, Gervasio A Lamas, Alexandre M Benjo, Joseph LamelasAbstract:OBJECTIVES: We hypothesize that minimally invasive valve surgery in patients with chronic obstructive pulmonary disease (COPD) is superior to the conventional median Sternotomy approach. METHODS: We retrospectively reviewed 2846 consecutive surgery performed at our institution between January 2005 and September 2010, and identified 165 patients with COPD who underwent isolated valve surgery. In-hospital mortality, composite complication rates, intensive care unit and total hospital length of stay of those who had undergone a minimally invasive approach were compared with a cohort that underwent a standard median Sternotomy approach. RESULTS: Of the 165 patients, 100 underwent a minimally invasive approach and 65 had a median Sternotomy. Baseline characteristics did not differ between the two groups. The mean age was 71±11 years for the minimally invasive group and 68±12 years for the median Sternotomy group, (P=0.31). In-hospital mortality was 1 (1%) in the minimally invasive group and 3 (5%) in the median Sternotomy group, P=0.14. Composite postoperative complications were significantly reduced in the minimally invasive group (30 versus 54%, P=0.002). The median intensive care unit length of stay was 47 h (IQR 40–70) versus 73 h (IQR 51–112), P<0.001, and the median postoperative length of stay was 6 days (IQR 5–9) versus 9 days (IQR 7–13), P<0.001, for the minimally invasive and the median Sternotomy groups, respectively. CONCLUSIONS: Minimally invasive valve surgery in patients with COPD is associated with excellent short-term results, and thus should be considered an option in these patients.
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outcomes of a minimally invasive approach compared with median Sternotomy for the excision of benign cardiac masses
The Annals of Thoracic Surgery, 2011Co-Authors: Andres M Pineda, Orlando Santana, Gervasio A Lamas, Alexandre M Benjo, Carlos Zamora, Joseph LamelasAbstract:Background We hypothesize that for the excision of benign cardiac masses, a minimally invasive approach through a right minithoracotomy is safe and feasible, and has lower resource utilization when compared with a standard median Sternotomy. Methods We retrospectively analyzed 39 consecutive patients who underwent benign cardiac mass excision at our institution between December 1999 and April 2010. The in-hospital outcomes of patients who had a right minithoracotomy were compared with those of patients who underwent a standard median Sternotomy. Results Of the 39 patients, 22 had cardiac masses removed through a minimally invasive approach, and 17 had a median Sternotomy. The type of masses resected included 26 myxomas (66.7%), 9 papillary fibroelastomas (23.1%), and 4 thrombi (10.2%). The aortic cross-clamp and cardiopulmonary bypass times were 43 minutes (interquartile range [IQR] 30 to 64) versus 31 minutes (IQR 23 to 47; p = 0.20) and 78 minutes (IQR 55 to 88) versus 57 minutes (IQR 33 to 70; p = 0.02) for the minimally invasive group and the median Sternotomy group, respectively. There were no significant differences in postoperative complications including mortality. The mean intensive care unit and hospital lengths of stay were 27 hours (IQR 24 to 47) versus 60 hours (IQR 48 to 79; p = 0.001) and 5 days (IQR 4 to 6) versus 7 days (IQR 6 to 8; p = 0.03) for the minimally invasive and the median Sternotomy group, respectively. Conclusions A minimally invasive approach through a right minithoracotomy for the resection of benign cardiac masses can be performed safely with lower resource utilization, and should be considered for these patients.
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outcomes of minimally invasive valve surgery versus standard Sternotomy in obese patients undergoing isolated valve surgery
The Annals of Thoracic Surgery, 2011Co-Authors: Orlando Santana, Javier Reyna, Gervasio A Lamas, Robert Grana, Mauricio Buendia, Joseph LamelasAbstract:Background We hypothesize that composite in-hospital surgical complications are lower in obese patients who undergo minimally invasive valve surgery for aortic and (or) mitral valve disease, when compared with the standard median Sternotomy approach. Methods We retrospectively reviewed 2,288 heart operations done at our institution between January 3, 2005 and January 10, 2010, and identified 160 consecutive obese patients, defined as patients with a body mass index of greater than 30 kg/m 2 , who underwent isolated mitral and (or) aortic valve surgery. The outcomes of those who had minimally invasive valve surgery were compared with a matched control group who had valve surgery through a median Sternotomy approach. Results Of the 160 patients, 64 underwent the minimally invasive approach and 96 had a median Sternotomy. The mean age was 69.4 ± 11 years for the minimally invasive group, and 64.7 ± 11.5 for the median Sternotomy group ( p = 0.015). Composite postoperative complications occurred in 15 (23.49%) versus 49 (51.0%) patients ( p = 0.034) in the minimally invasive group versus median Sternotomy, respectively. The difference was driven by a lower incidence of acute renal failure (0 vs 6 patients [6.25%], p = 0.041), prolonged intubation (12 [18.7%] vs 33 [34.3%], p = 0.049), reintubation (3 [4.68%] vs 15 [15.6%], p = 0.032), deep wound infections (0 vs 4 [4.1%], p = 0.098), and death (0 vs 8 [8.3%], p = 0.041), respectively. All patients in the minimally invasive group were alive at 30 days. Conclusions Minimally invasive surgery for isolated valve lesions in obese patients has a lower morbidity and mortality when compared with the standard median Sternotomy approach.
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outcomes of minimally invasive valve surgery versus median Sternotomy in patients age 75 years or greater
The Annals of Thoracic Surgery, 2011Co-Authors: Joseph Lamelas, Andres M Pineda, Orlando Santana, Alejandro Sarria, Gervasio A LamasAbstract:Background Advanced age is a major predictor of poor outcome in patients undergoing valve surgery. We hypothesized that elderly patients who underwent minimally invasive valve surgery for aortic or mitral valve disease would do better when compared with those undergoing the standard median Sternotomy. Methods We retrospectively reviewed 2,107 consecutive heart operations at our institution and identified 203 patients, age 75 years or greater, who underwent isolated mitral or aortic valve surgery. Outcomes of those who had minimally invasive valve surgery through a right minithoracotomy were compared with those who had a median Sternotomy. Results Of the 203 patients, 119 (59%) underwent a minimally invasive approach, while 84 (41%) had a median Sternotomy. The median postoperative length of stay was 7 days (interquartile range [IQR] 6 to 10) versus 12 days (IQR 9 to 20), p less than 0.001, and intensive care unit length of stay was 52 hours (IQR 44 to 93) versus 119 hours (IQR 57 to 193), p less than 0.001 for minimally invasive and median Sternotomy, respectively. In-hospital mortality was 2 (1.7%) versus 8 (9.5%, p=0.01 and composite postoperative morbidity and mortality occurred in 25 (21%) versus 38 (45.2%), p less than 0.001, in minimally invasive versus median Sternotomy, respectively. The difference was driven by the following: a lower incidence of acute renal failure, 1 (0.8%) versus 14 (16.7%), p less than 0.001; prolonged intubation 23 (19.3%) versus 32 (38.1%), p=0.003; wound infections 1 (0.8%) versus 5 (6%), p=0.034; and death. Conclusions Minimally invasive surgery for isolated valve lesions in elderly patients yields a lower morbidity and mortality when compared with median Sternotomy and should be considered when such individuals require valve surgery.
Orlando Santana - One of the best experts on this subject based on the ideXlab platform.
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outcomes of reoperative aortic valve replacement via right mini thoracotomy versus median Sternotomy
Journal of Heart Valve Disease, 2013Co-Authors: Andres M Pineda, Orlando Santana, Javier Reyna, Alejandro Sarria, Gervasio A Lamas, Joseph LamelasAbstract:Background and aim of the study: The study aim was to determine the safety and efficacy of a minimally invasive right mini-thoracotomy for aortic valve replacement (AVR) in patients who had undergone previous median Sternotomy. Methods: Between January 2005 and December 2011, a total of 3,603 consecutive cases was retrospectively reviewed to identify patients with previous median Sternotomy who subsequently underwent AVR. The outcomes of patients having minimally invasive surgery were compared with those in whom a median Sternotomy approach had been employed. Results: Among 77 patients identified, 36 (47%) underwent a minimally invasive approach, and 41 (53%) had a median Sternotomy. The mean age of the minimally invasive group (33 males, three females) was 75.3 ± 9.0 years, and that of the median Sternotomy group (33 males, eight females) was 68.2 ± 13.6 years (p = 0.009). The minimally invasive group had more prior Sternotomy for coronary artery bypass graft surgery (86% versus 59%, p = 0.007), and fewer for prior valve surgery (33% versus 59%, p = 0.02). In-hospital mortality was zero for the minimally invasive cohort versus four (10%) in the median Sternotomy group (p = 0.08); composite postoperative complications occurred in six (17%) versus 19 (46%) (p = 0.005) of these two groups, respectively. The median intensive care unit and total hospital length of stay were 48 h [interquartile range (IQR) 41-97] versus 69 h [IQR 45-174] (p = 0.03), and seven days [IQR 5-10] versus 9 days [IQR 7-15] (p = 0.03) for the minimally invasive and median Sternotomy group, respectively. Conclusion: Minimally invasive AVR via a right mini-thoracotomy in patients with previous cardiac surgery can be performed safely, and is associated with shorter intensive care unit and total hospital stays, a lower morbidity, and a trend towards lower mortality.
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outcomes of minimally invasive valve surgery in patients with chronic obstructive pulmonary disease
European Journal of Cardio-Thoracic Surgery, 2012Co-Authors: Orlando Santana, Javier Reyna, Gervasio A Lamas, Alexandre M Benjo, Joseph LamelasAbstract:OBJECTIVES: We hypothesize that minimally invasive valve surgery in patients with chronic obstructive pulmonary disease (COPD) is superior to the conventional median Sternotomy approach. METHODS: We retrospectively reviewed 2846 consecutive surgery performed at our institution between January 2005 and September 2010, and identified 165 patients with COPD who underwent isolated valve surgery. In-hospital mortality, composite complication rates, intensive care unit and total hospital length of stay of those who had undergone a minimally invasive approach were compared with a cohort that underwent a standard median Sternotomy approach. RESULTS: Of the 165 patients, 100 underwent a minimally invasive approach and 65 had a median Sternotomy. Baseline characteristics did not differ between the two groups. The mean age was 71±11 years for the minimally invasive group and 68±12 years for the median Sternotomy group, (P=0.31). In-hospital mortality was 1 (1%) in the minimally invasive group and 3 (5%) in the median Sternotomy group, P=0.14. Composite postoperative complications were significantly reduced in the minimally invasive group (30 versus 54%, P=0.002). The median intensive care unit length of stay was 47 h (IQR 40–70) versus 73 h (IQR 51–112), P<0.001, and the median postoperative length of stay was 6 days (IQR 5–9) versus 9 days (IQR 7–13), P<0.001, for the minimally invasive and the median Sternotomy groups, respectively. CONCLUSIONS: Minimally invasive valve surgery in patients with COPD is associated with excellent short-term results, and thus should be considered an option in these patients.
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outcomes of a minimally invasive approach compared with median Sternotomy for the excision of benign cardiac masses
The Annals of Thoracic Surgery, 2011Co-Authors: Andres M Pineda, Orlando Santana, Gervasio A Lamas, Alexandre M Benjo, Carlos Zamora, Joseph LamelasAbstract:Background We hypothesize that for the excision of benign cardiac masses, a minimally invasive approach through a right minithoracotomy is safe and feasible, and has lower resource utilization when compared with a standard median Sternotomy. Methods We retrospectively analyzed 39 consecutive patients who underwent benign cardiac mass excision at our institution between December 1999 and April 2010. The in-hospital outcomes of patients who had a right minithoracotomy were compared with those of patients who underwent a standard median Sternotomy. Results Of the 39 patients, 22 had cardiac masses removed through a minimally invasive approach, and 17 had a median Sternotomy. The type of masses resected included 26 myxomas (66.7%), 9 papillary fibroelastomas (23.1%), and 4 thrombi (10.2%). The aortic cross-clamp and cardiopulmonary bypass times were 43 minutes (interquartile range [IQR] 30 to 64) versus 31 minutes (IQR 23 to 47; p = 0.20) and 78 minutes (IQR 55 to 88) versus 57 minutes (IQR 33 to 70; p = 0.02) for the minimally invasive group and the median Sternotomy group, respectively. There were no significant differences in postoperative complications including mortality. The mean intensive care unit and hospital lengths of stay were 27 hours (IQR 24 to 47) versus 60 hours (IQR 48 to 79; p = 0.001) and 5 days (IQR 4 to 6) versus 7 days (IQR 6 to 8; p = 0.03) for the minimally invasive and the median Sternotomy group, respectively. Conclusions A minimally invasive approach through a right minithoracotomy for the resection of benign cardiac masses can be performed safely with lower resource utilization, and should be considered for these patients.
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outcomes of minimally invasive valve surgery versus standard Sternotomy in obese patients undergoing isolated valve surgery
The Annals of Thoracic Surgery, 2011Co-Authors: Orlando Santana, Javier Reyna, Gervasio A Lamas, Robert Grana, Mauricio Buendia, Joseph LamelasAbstract:Background We hypothesize that composite in-hospital surgical complications are lower in obese patients who undergo minimally invasive valve surgery for aortic and (or) mitral valve disease, when compared with the standard median Sternotomy approach. Methods We retrospectively reviewed 2,288 heart operations done at our institution between January 3, 2005 and January 10, 2010, and identified 160 consecutive obese patients, defined as patients with a body mass index of greater than 30 kg/m 2 , who underwent isolated mitral and (or) aortic valve surgery. The outcomes of those who had minimally invasive valve surgery were compared with a matched control group who had valve surgery through a median Sternotomy approach. Results Of the 160 patients, 64 underwent the minimally invasive approach and 96 had a median Sternotomy. The mean age was 69.4 ± 11 years for the minimally invasive group, and 64.7 ± 11.5 for the median Sternotomy group ( p = 0.015). Composite postoperative complications occurred in 15 (23.49%) versus 49 (51.0%) patients ( p = 0.034) in the minimally invasive group versus median Sternotomy, respectively. The difference was driven by a lower incidence of acute renal failure (0 vs 6 patients [6.25%], p = 0.041), prolonged intubation (12 [18.7%] vs 33 [34.3%], p = 0.049), reintubation (3 [4.68%] vs 15 [15.6%], p = 0.032), deep wound infections (0 vs 4 [4.1%], p = 0.098), and death (0 vs 8 [8.3%], p = 0.041), respectively. All patients in the minimally invasive group were alive at 30 days. Conclusions Minimally invasive surgery for isolated valve lesions in obese patients has a lower morbidity and mortality when compared with the standard median Sternotomy approach.
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outcomes of minimally invasive valve surgery versus median Sternotomy in patients age 75 years or greater
The Annals of Thoracic Surgery, 2011Co-Authors: Joseph Lamelas, Andres M Pineda, Orlando Santana, Alejandro Sarria, Gervasio A LamasAbstract:Background Advanced age is a major predictor of poor outcome in patients undergoing valve surgery. We hypothesized that elderly patients who underwent minimally invasive valve surgery for aortic or mitral valve disease would do better when compared with those undergoing the standard median Sternotomy. Methods We retrospectively reviewed 2,107 consecutive heart operations at our institution and identified 203 patients, age 75 years or greater, who underwent isolated mitral or aortic valve surgery. Outcomes of those who had minimally invasive valve surgery through a right minithoracotomy were compared with those who had a median Sternotomy. Results Of the 203 patients, 119 (59%) underwent a minimally invasive approach, while 84 (41%) had a median Sternotomy. The median postoperative length of stay was 7 days (interquartile range [IQR] 6 to 10) versus 12 days (IQR 9 to 20), p less than 0.001, and intensive care unit length of stay was 52 hours (IQR 44 to 93) versus 119 hours (IQR 57 to 193), p less than 0.001 for minimally invasive and median Sternotomy, respectively. In-hospital mortality was 2 (1.7%) versus 8 (9.5%, p=0.01 and composite postoperative morbidity and mortality occurred in 25 (21%) versus 38 (45.2%), p less than 0.001, in minimally invasive versus median Sternotomy, respectively. The difference was driven by the following: a lower incidence of acute renal failure, 1 (0.8%) versus 14 (16.7%), p less than 0.001; prolonged intubation 23 (19.3%) versus 32 (38.1%), p=0.003; wound infections 1 (0.8%) versus 5 (6%), p=0.034; and death. Conclusions Minimally invasive surgery for isolated valve lesions in elderly patients yields a lower morbidity and mortality when compared with median Sternotomy and should be considered when such individuals require valve surgery.
Eugene H Blackstone - One of the best experts on this subject based on the ideXlab platform.
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robotic repair of posterior mitral valve prolapse versus conventional approaches potential realized
The Journal of Thoracic and Cardiovascular Surgery, 2011Co-Authors: Tomislav Mihaljevic, Marc A Gillinov, Lars G Svensson, Craig M Jarrett, Sarah J Williams, Pierre Devilliers, William J Stewart, Joseph F Sabik, Eugene H BlackstoneAbstract:Objective Robotic mitral valve repair is the least invasive approach to mitral valve repair, yet there are few data comparing its outcomes with those of conventional approaches. Therefore, we compared outcomes of robotic mitral valve repair with those of complete Sternotomy, partial Sternotomy, and right mini-anterolateral thoracotomy. Methods From January 2006 to January 2009, 759 patients with degenerative mitral valve disease and posterior leaflet prolapse underwent primary isolated mitral valve surgery by complete Sternotomy (n = 114), partial Sternotomy (n = 270), right mini-anterolateral thoracotomy (n = 114), or a robotic approach (n = 261). Outcomes were compared on an intent-to-treat basis using propensity-score matching. Results Mitral valve repair was achieved in all patients except 1 patient in the complete Sternotomy group. In matched groups, median cardiopulmonary bypass time was 42 minutes longer for robotic than complete Sternotomy, 39 minutes longer than partial Sternotomy, and 11 minutes longer than right mini-anterolateral thoracotomy ( P 0001); median myocardial ischemic time was 26 minutes longer than complete Sternotomy and partial Sternotomy, and 16 minutes longer than right mini-anterolateral thoracotomy ( P 0001). Quality of mitral valve repair was similar among matched groups ( P = .6, .2, and .1, respectively). There were no in-hospital deaths. Neurologic, pulmonary, and renal complications were similar among groups ( P > .1). The robotic group had the lowest occurrences of atrial fibrillation and pleural effusion, contributing to the shortest hospital stay (median 4.2 days), 1.0, 1.6, and 0.9 days shorter than for complete Sternotomy, partial Sternotomy, and right mini-anterolateral thoracotomy (all P .001), respectively. Conclusions Robotic repair of posterior mitral valve leaflet prolapse is as safe and effective as conventional approaches. Technical complexity and longer operative times for robotic repair are compensated for by lesser invasiveness and shorter hospital stay.
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does right thoracotomy increase the risk of mitral valve reoperation
The Journal of Thoracic and Cardiovascular Surgery, 2007Co-Authors: Lars G Svensson, Marc A Gillinov, Eugene H Blackstone, Penny L Houghtaling, Kyung Hwan Kim, Gosta B Pettersson, Nicholas G Smedira, Michael K Banbury, Bruce W LytleAbstract:Objective The study objective was to determine whether a right thoracotomy approach increases the risk of mitral valve reoperation. Methods Between January of 1993 and January of 2004, 2469 patients with mitral valve disease underwent 2570 reoperations (1508 replacements, 1062 repairs). The approach was median Sternotomy in 2444 patients, right thoracotomy in 80 patients, and other in 46 patients. Multivariable logistic regression was used to identify factors associated with median Sternotomy versus right thoracotomy, mitral valve repair versus replacement, hospital death, and stroke. Factors favoring median Sternotomy ( P Results Hospital mortality was 6.7% (163/2444) for the median Sternotomy approach and 6.3% (5/80) for the thoracotomy approach ( P = .9). Risk factors ( P P = .006). Mitral valve replacement (vs repair) was more common in those receiving a thoracotomy ( P Conclusions Compared with median Sternotomy, right thoracotomy is associated with a higher occurrence of stroke and less frequent mitral valve repair. Specific strategies for conducting the operation should be used to reduce the risk of stroke when right thoracotomy is used for mitral valve reoperation. In most instances, repeat median Sternotomy, with its better exposure and greater latitude for concomitant procedures, is preferred.
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does right thoracotomy increase the risk of mitral valve reoperation
The Journal of Thoracic and Cardiovascular Surgery, 2007Co-Authors: Lars G Svensson, Marc A Gillinov, Eugene H Blackstone, Penny L Houghtaling, Kyung Hwan Kim, Gosta B Pettersson, Nicholas G Smedira, Michael K Banbury, Bruce W LytleAbstract:Objective The study objective was to determine whether a right thoracotomy approach increases the risk of mitral valve reoperation. Methods Between January of 1993 and January of 2004, 2469 patients with mitral valve disease underwent 2570 reoperations (1508 replacements, 1062 repairs). The approach was median Sternotomy in 2444 patients, right thoracotomy in 80 patients, and other in 46 patients. Multivariable logistic regression was used to identify factors associated with median Sternotomy versus right thoracotomy, mitral valve repair versus replacement, hospital death, and stroke. Factors favoring median Sternotomy (P Results Hospital mortality was 6.7% (163/2444) for the median Sternotomy approach and 6.3% (5/80) for the thoracotomy approach (P = .9). Risk factors (P Conclusions Compared with median Sternotomy, right thoracotomy is associated with a higher occurrence of stroke and less frequent mitral valve repair. Specific strategies for conducting the operation should be used to reduce the risk of stroke when right thoracotomy is used for mitral valve reoperation. In most instances, repeat median Sternotomy, with its better exposure and greater latitude for concomitant procedures, is preferred.
Marc A Gillinov - One of the best experts on this subject based on the ideXlab platform.
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value of robotically assisted surgery for mitral valve disease
JAMA Surgery, 2014Co-Authors: Tomislav Mihaljevic, Marc A Gillinov, Craig M Jarrett, Sarah J Williams, Marijan Koprivanac, Marta Kelava, Avi Goodman, Gurjyot Bajwa, Stephanie Mick, Johannes BonattiAbstract:Importance The value of robotically assisted surgery for mitral valve disease is questioned because the high cost of care associated with robotic technology may outweigh its clinical benefits. Objective To investigate conditions under which benefits of robotically assisted surgery mitigate high technology costs. Design, Setting, and Participants Clinical cohort study at a large multispecialty academic medical center comparing costs of robotically assisted surgery with 3 contemporaneous conventional surgical approaches for degenerative mitral valve disease. From January 1, 2006, through December 31, 2010, a total of 1290 patients with a mean (SD) age of 57 (11) years underwent mitral valve repair for regurgitation from posterior leaflet prolapse. Robotically assisted surgery was performed in 473 patients, complete Sternotomy in 227, partial Sternotomy in 349, and anterolateral thoracotomy in 241. Comparisons were based on intent to treat, with 3 propensity-matched groups formed based on demographics, symptoms, cardiac and noncardiac comorbidities, valve pathophysiologic disorders, and echocardiographic measurements: robotic vs Sternotomy (198 pairs) vs partial Sternotomy (293 pairs) vs thoracotomy (224 pairs). Interventions Mitral valve repair. Main Outcomes and Measures Cost of care (expressed as robotic capital investment, maintenance of equipment, and direct technical hospital costs) and benefit of care (based on differences in recovery time). Results Cost of care (median [15th and 85th percentiles]) for robotically assisted surgery exceeded that of alternative approaches by 26.8% (–5.3% and 67.9%), 32.1% (–6.1% and 69.6%), and 20.7% (–2.4% and 48.4%) for complete Sternotomy, partial Sternotomy, and anterolateral thoracotomy, respectively. Higher operative costs were partially offset by lower postoperative costs and earlier return to work: a median (15th and 85th percentiles) of 35 (19 and 63) days for robotically assisted surgery, 49 (21 and 109) days for complete Sternotomy, 56 (30 and 119) days for partial Sternotomy, and 42 (18 and 90) days for anterolateral thoracotomy. Resulting net differences (median [15th and 85th percentiles]) in the cost of robotic surgery vs the 3 alternatives were 15.6% (–14.7% and 55.1%), 15.7% (–19.4% and 51.2%), and 14.8% (–7.4% and 43.6%), respectively. Beyond a volume threshold of 55 to 100 robotically assisted operations per year, distribution of the cost of this technology broadly overlapped those of conventional approaches. Conclusions and Relevance In exchange for higher procedural costs, robotically assisted surgery for mitral valve repair offers the clinical benefit of least-invasive surgery, lowest postoperative cost, and fastest return to work. The value of robotically assisted surgery that is similar to that of conventional approaches can be realized only in high-volume centers.
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robotic repair of posterior mitral valve prolapse versus conventional approaches potential realized
The Journal of Thoracic and Cardiovascular Surgery, 2011Co-Authors: Tomislav Mihaljevic, Marc A Gillinov, Lars G Svensson, Craig M Jarrett, Sarah J Williams, Pierre Devilliers, William J Stewart, Joseph F Sabik, Eugene H BlackstoneAbstract:Objective Robotic mitral valve repair is the least invasive approach to mitral valve repair, yet there are few data comparing its outcomes with those of conventional approaches. Therefore, we compared outcomes of robotic mitral valve repair with those of complete Sternotomy, partial Sternotomy, and right mini-anterolateral thoracotomy. Methods From January 2006 to January 2009, 759 patients with degenerative mitral valve disease and posterior leaflet prolapse underwent primary isolated mitral valve surgery by complete Sternotomy (n = 114), partial Sternotomy (n = 270), right mini-anterolateral thoracotomy (n = 114), or a robotic approach (n = 261). Outcomes were compared on an intent-to-treat basis using propensity-score matching. Results Mitral valve repair was achieved in all patients except 1 patient in the complete Sternotomy group. In matched groups, median cardiopulmonary bypass time was 42 minutes longer for robotic than complete Sternotomy, 39 minutes longer than partial Sternotomy, and 11 minutes longer than right mini-anterolateral thoracotomy ( P 0001); median myocardial ischemic time was 26 minutes longer than complete Sternotomy and partial Sternotomy, and 16 minutes longer than right mini-anterolateral thoracotomy ( P 0001). Quality of mitral valve repair was similar among matched groups ( P = .6, .2, and .1, respectively). There were no in-hospital deaths. Neurologic, pulmonary, and renal complications were similar among groups ( P > .1). The robotic group had the lowest occurrences of atrial fibrillation and pleural effusion, contributing to the shortest hospital stay (median 4.2 days), 1.0, 1.6, and 0.9 days shorter than for complete Sternotomy, partial Sternotomy, and right mini-anterolateral thoracotomy (all P .001), respectively. Conclusions Robotic repair of posterior mitral valve leaflet prolapse is as safe and effective as conventional approaches. Technical complexity and longer operative times for robotic repair are compensated for by lesser invasiveness and shorter hospital stay.
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does right thoracotomy increase the risk of mitral valve reoperation
The Journal of Thoracic and Cardiovascular Surgery, 2007Co-Authors: Lars G Svensson, Marc A Gillinov, Eugene H Blackstone, Penny L Houghtaling, Kyung Hwan Kim, Gosta B Pettersson, Nicholas G Smedira, Michael K Banbury, Bruce W LytleAbstract:Objective The study objective was to determine whether a right thoracotomy approach increases the risk of mitral valve reoperation. Methods Between January of 1993 and January of 2004, 2469 patients with mitral valve disease underwent 2570 reoperations (1508 replacements, 1062 repairs). The approach was median Sternotomy in 2444 patients, right thoracotomy in 80 patients, and other in 46 patients. Multivariable logistic regression was used to identify factors associated with median Sternotomy versus right thoracotomy, mitral valve repair versus replacement, hospital death, and stroke. Factors favoring median Sternotomy ( P Results Hospital mortality was 6.7% (163/2444) for the median Sternotomy approach and 6.3% (5/80) for the thoracotomy approach ( P = .9). Risk factors ( P P = .006). Mitral valve replacement (vs repair) was more common in those receiving a thoracotomy ( P Conclusions Compared with median Sternotomy, right thoracotomy is associated with a higher occurrence of stroke and less frequent mitral valve repair. Specific strategies for conducting the operation should be used to reduce the risk of stroke when right thoracotomy is used for mitral valve reoperation. In most instances, repeat median Sternotomy, with its better exposure and greater latitude for concomitant procedures, is preferred.
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does right thoracotomy increase the risk of mitral valve reoperation
The Journal of Thoracic and Cardiovascular Surgery, 2007Co-Authors: Lars G Svensson, Marc A Gillinov, Eugene H Blackstone, Penny L Houghtaling, Kyung Hwan Kim, Gosta B Pettersson, Nicholas G Smedira, Michael K Banbury, Bruce W LytleAbstract:Objective The study objective was to determine whether a right thoracotomy approach increases the risk of mitral valve reoperation. Methods Between January of 1993 and January of 2004, 2469 patients with mitral valve disease underwent 2570 reoperations (1508 replacements, 1062 repairs). The approach was median Sternotomy in 2444 patients, right thoracotomy in 80 patients, and other in 46 patients. Multivariable logistic regression was used to identify factors associated with median Sternotomy versus right thoracotomy, mitral valve repair versus replacement, hospital death, and stroke. Factors favoring median Sternotomy (P Results Hospital mortality was 6.7% (163/2444) for the median Sternotomy approach and 6.3% (5/80) for the thoracotomy approach (P = .9). Risk factors (P Conclusions Compared with median Sternotomy, right thoracotomy is associated with a higher occurrence of stroke and less frequent mitral valve repair. Specific strategies for conducting the operation should be used to reduce the risk of stroke when right thoracotomy is used for mitral valve reoperation. In most instances, repeat median Sternotomy, with its better exposure and greater latitude for concomitant procedures, is preferred.
