The authors present their experience with totally endoscopic beating mitral valve surgery by presenting this case of mitral repair. They recently moved to beating mitral surgery due to the shortage of the endo-balloon aortic clamp which was their preferred method of myocardial protection. Their team does not feel very comfortable using the external clamps (Chitwood Clamp). Since last year, the authors started performing most of their endoscopic mitral and/or tricuspid endoscopic surgeries on a beating heart with favorable outcomes. This video presents their technique and pitfalls.
Disclosure
Joseph Zacharias is a proctor for Edwards Lifescience, Abbott, and Cryolife.
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Excellent work Joe!!!
Very useful technique especially in REDO cases when you do not want to dissect the aorta (e.g. top ends or a RIMA passing through) or in cases with porcelain aorta.
Thank you for sharing!
Good video! How did you avoid the air embolism?
Very excellent technique. But what about the risk of air embolism with opened left Atrium without aorta clamping?
Thank you for your efforts!
Thank you Antonios. I have learned a lot from your videos so really appreciate your positive feedback. We started our experience with complex redo cases as you mention but have gradually moved to using it for first time cases. We were encouraged by papers from Dr Niv Ad’s group using Ventricular fibrillation and Dr Cameron’s group in Edinburgh with a large experience of redo beating heart mitral surgery using a right lateral thoracotomy.
As Mahmoud and Yahel ask, air embolism is a constant concern and it is a bigger problem after the mitral valve has been repaired and is competent. We do place two suckers in the LV and do spend some time de-airing. TOE is very helpful to know when to remove the suckers. In some redo cases where the LV is adherent to the sternum a pocket of air at the tip can be very difficult to get. This involves moving the table around and sometimes even chest compressions to dislodge the air into the sucker!! De-airing is a lot easier in first time cases but I will fully agree that it should be a concern doing these procedures. I would not recommend this approach early in the learning curve of endoscopic mitral valve surgery.
Thank you for your comments and interest.