title: Feasibility of mitral valve surgery using minimal extracorporeal     circulation.
abstract: OBJECTIVE
  Using minimal extracorporeal circulation (MECC) in isolated coronary artery bypass grafting or aortic valve replacement has been proven to be safe, feasible and superior compared to standard cardiopulmonary bypass (CPB) in terms of postoperative complications, total hospital stay and blood product transfusions. This feasibility study evaluates the clinical outcomes of mitral valve surgery performed with MECC.
  
  
  METHODS
  From March 2006 to January 2011, seventy-five patients who underwent mitral valve surgery performed with MECC (n=75) in our institution were retrospectively evaluated. Demographic characteristics, operative data and clinical outcomes were collected in a prospectively designed database.
  
  
  RESULTS
  The mean age was 68.8 ± 10.2 years with a EuroSCORE of 7.0 ± 2.3. Thirty-seven patients had a moderate left ventricular function (with a range of 30-40%). All patients except two had severe mitral valve incompetence (MI). Surgery was successful in all procedures. The mean duration of surgery was 210 ± 44 min (range 118-356 min). The mean CPB time was 128 ± 30 (range 67-249) min. The cross-clamp time was 99 ± 26 (range 48-205) min. There were no intraoperative perfusion problems or airlocks reported. The mean intensive care unit (ICU) length of stay was two days. Subsequent analysis showed a first postoperative haemoglobin value of 9.4 g/dL ± 1.7. There were no peroperative neurological complications. One patient developed an ischaemic cerebrovascular accident (CVA) on the forth postoperative day due to inadequate anticoagulation. Other postoperative complications included eight patients with pneumonia, one superficial wound infection, temporary renal insufficiency in two patients and four patients needed re-exploration for excessive postoperative leakage. Overall in-hospital mortality was four percent.
  
  
  CONCLUSIONS
  Our results show, for the first time, that isolated or combined mitral valve surgery using MECC is feasible and safe.
authors.affiliation: Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Sjatskig
authors.forename: A
authors.initials: A
authors.lastname: Yilmaz
authors.forename: J W
authors.initials: JW
authors.lastname: van Boven
authors.forename: U
authors.initials: U
authors.lastname: Sonker
authors.forename: F G
authors.initials: FG
authors.lastname: Waanders
authors.forename: G T L
authors.initials: GT
authors.lastname: Kloppenburg
mesh_terms: D000368:Aged; D003422:Critical Care; D005112:Extracorporeal Circulation / Q000379:methods*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D016277:Ventricular Function, Left