Pervaiz Chaudry
Diplomate American Boards of Cardiothoracic Surgery, USA
Title: Initial experience of minimally invasive concomitant aortic & mitral valve replacement / repair at a tertiary care cardiac centre of a developing country
Biography
Biography: Pervaiz Chaudry
Abstract
Introduction: Minimally invasive double valve replacement (DVR) surgery through a small transverse anterior thoracotomy is an alternate technique than sternotomy for concomitant aortic and mitral valve (AVR, MVR)surgery that
can reduce surgical stress and length of hospital stay. Endoscopy and robot-assisted surgery is being practised in developed countries but its technically very difficult, time-consuming, costly and not reproducible by all surgeons. As median sternotomy is preferred approach for DVR, therefore, we aimed to introduce direct vision minimal invasive DVR (DVMI-DVR) to the surgeons in our setting for common public.
Objectives: Aim of this research was to evaluate the in hospital and early outcomes of direct vision minimal invasive double valve surgery at a tertiary care cardiac centre of a developing country.
Patients And Methods: This prospective observation study was conducted at National Institute of Cardiovascular Diseases Karachi, Pakistan from January 2018 to September 2018. 19 consecutive patients undergoing DVMI-DVR for aortic and mitral disease without any prior cardiac surgery were included in this study. For all procedures access was through small transverse anterior thoracotomy incision with wedge resection (Chaudhry’s Wedge) of sternum opposite to 3rdand 4thcosto-sternal joints. Patients were observed during hospital stay and were followed to observe length of hospital stay(LOHS), ventilatory support, pain score, and mortality. Data were entered and analysed using SPSS version 23.
Results: The male/female ratio was 11:8 with mean age of 35± 12 years.Mean total bypass time was 129.8 ± 23.83 min (range 98-181 mins).Mean mechanical ventilation time was 3.16± 1.12 h (range 2–6 h). Mean post operative LOHS was 5.63 ± 1.12 days (range 4–8 days). We had zero surgical mortality. Mean pain score of 4.32 (on predefined pain scale of 1 to 9 with high
value indicating severe pain).
Conclusions: Minimally Invasive DVR surgery is a safe and reproducible technique with the acceptable surgical outcome. It carries good post-operative recovery, patient’s satisfaction and early return to daily activity.