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ISMICS 2024 Annual Meeting
29 May - 1 June, 2024 | Athens, Greece
PC.132
Thoracoscopic Mitral Valve Replacement Using The “Chimney” Technique
Poster Presenter
Part of Topic
Global
Video
Thoracoscopic Mitral Valve Replacement Using the Chimney Technique: A Case Report
Background
Thoracoscopic mitral valve replacement is a common technique in cardiac surgery. Calcification of the annulus and a small left ventricle are the difficulties in thoracoscopic mitral valve surgery. Improper treatment for patients with these features can cause left ventricular rupture or prosthesis-patient mismatch.
Methods
We performed a thoracoscopic mitral bioprosthesis replacement using the “chimney” technique for a 74-year-old female with severe mitral stenosis. The patient had dyspnea on exertion for 7 years and had a history of stroke 5 years before this admission. Severe mitral valve stenosis/regurgitation, and severe tricuspid regurgitation were found. Her left ventricle end-diastolic diameter was 41.2 mm, and calcification was found at the posteromedial commissure. The mitral valve orifice area was 0.7 cm², and pulmonary artery systolic pressure35 mmHg. The electrocardiogram indicated atrial fibrillation. EuroSCORE II: 6.34%. STSPROM: 11.30%.
Thoracoscopic mitral valve replacement using the chimney technique (see the video), tricuspid valve repair, and left atrial appendage were performed. The body surface area was 1.44 m², and a 25 # mitral bioprosthesis was implanted. No mitral regurgitation/stenosis in transesophageal imaging. Total operation time: 330 mins. Cardiopulmonary bypass time: 219 mins. Aortic cross clamp time: 135 mins. Postoperative ventilation time: 10 hrs. Intensive care unit stay time: 43.5 hrs. Postoperative stay: 8 days. Transthoracic echocardiogram showed neither mitral stenosis nor paravalvular regurgitation before discharge. The patient recovered at a 4-month follow-up visit.
Conclusions
The surgical effect was satisfactory, and no complications occurred. Thoracoscopic mitral bioprosthesis replacement using the "chimney" technique is safe and effective for selected patients.