title: Echocardiographic assessment in minimally invasive mitral valve surgery.
abstract: BACKGROUND
  Due to limited exposure, removal of intracavitary air and visual assessment of cardiac function during minimally invasive procedures are not always possible. We analysed the utility of intraoperative transesophageal echocardiography (TEE) and postoperative transthoracic echocardiographic (TTE) in minimally invasive mitral valve (MV) procedures.
  
  
  METHODS
  We evaluated data from 163 consecutive patients undergoing isolated minimally invasive MV replacement (n=40) or repair (n=123) via small right anterolateral thoracotomy (121 complex mitral procedures). Cardioplegic arrest was achieved using either endoaortic (n=23) or transthoracic aortic clamp (n=140). In addition to preoperative TTE, TEE was used intraoperatively before and after cardiopulmonary bypass (CPB). Postoperative TTE was performed to monitor valve function at 3 and 12 months, and at 5-year follow-up.
  
  
  RESULTS
  Pre-CPB TEE was useful to assess valve dysfunction and assist in placement of the arterial and venous cannulas. During CPB, placement and positioning of the endoclamp were guided effectively in all but 4 patients, in whom recurrent balloon migration necessitated secondary transthoracic aortic clamping. TEE detected one acute retrograde aortic dissection and one circumflex artery occlusion. After 18.7+/-10.6 months follow-up, all patients except three improved symptomatically and had consistently good valve function.
  
  
  CONCLUSIONS
  Intraoperative TEE is essential for minimally invasive MV surgery, because it allows immediate control of valve function before and after surgery. It is useful to detect unexpected complications requiring immediate remedy. Postoperative echocardiographic results show that minimally invasive MV surgery is a good alternative to conventional surgery even in complex MV repairs.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt/Main 60590, Germany. tayfun@aybek.de
authors.forename: Tayfun
authors.initials: T
authors.lastname: Aybek
authors.forename: Mirko
authors.initials: M
authors.lastname: Doss
authors.forename: Ulf
authors.initials: U
authors.lastname: Abdel-Rahman
authors.forename: Andreas
authors.initials: A
authors.lastname: Simon
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Miskovic
authors.forename: Petar S
authors.initials: PS
authors.lastname: Risteski
authors.forename: Selami
authors.initials: S
authors.lastname: Dogan
authors.forename: Anton
authors.initials: A
authors.lastname: Moritz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017548:Echocardiography, Transesophageal; D005260:Female; D006334:Heart Function Tests; D006339:Heart Rate; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000175:diagnosis; D016343:Monitoring, Intraoperative / Q000379:methods