Outcomes of Barlow mitral valve repaired by robot-assisted keyhole surgery.

Objective: To present our strategy and the clinical outcomes of robot-assisted Barlow mitral valve keyhole surgery. Methods: From May 2015 to March 2022, a total of 1281 patients underwent mitral valve repair at our institution, including 763 with robotics surgeries. Of these, 124 patients with Barlow mitral valve (49 ± 12 years, male/female ratio = 81:43) were treated using robotic assistance and included in this study. Results: All operations were completed using 3 to 5 keyholes. Neochordae implantation using the loop technique was the first option, and resection was performed only in cases with an intrinsic risk of developing systolic anterior motion. Neochordae implantation was performed in 118 cases (95.1%) using 6.6 ± 3.0 neochordae. Posterior leaflet resection was performed in 27 (21.7%) patients. Operation time was 177 ± 42 minutes, cardiopulmonary bypass time was 127 ± 25 minutes, and aorta crossclamp time was 76 ± 16 minutes. Blood transfusion was required in 5 cases (4%). None of the patients required a conversion to valve replacement. The postoperative complications included bleeding (n = 4), stroke (n = 1), and infection (n = 2). Mitral valve regurgitation 1 week after repair was none or trivial in 122 cases (98.3%), mild in 2 cases (1.7%), and more than moderate in 0 cases. Freedom from reoperation was 99.2% during the follow-up period of 36 ± 21 months. One patient required reoperation due to infective endocarditis. Conclusions: Robot-assisted keyhole surgery using the loop-first concept was adequate to help achieve satisfactory and safe perioperative outcomes for Barlow mitral valve.

Off-Pump Neochordae Implantation via Left Minithoracotomy for Recurrent Regurgitation Following Mitral Valve Repair: The First Case in Japan.

Surgical fixation after recurrent regurgitation following surgical mitral repair has been technically demanding and associated with high morbidity and mortality. Avoiding reopening the adhesive site or limiting the usage of cardiopulmonary bypass are solutions for reducing the operative risk. We report a case of recurrent mitral regurgitation treated by off-pump neochordae implantation via left minithoracotomy. A 69-year-old woman with a history of conventional mitral repair via median sternotomy developed heart failure due to mitral regurgitation from recurrent posterior leaflet P2 prolapse. Four neochordaes were implanted off-pump via left minithoracotomy using a NeoChord DS1000 in the seventh intercostal space. No transfusion was required. The patient was discharged a week after the procedure with no complications. The regurgitation remains trivial 6 months after the NeoChord procedure.

Anterior Descending Coronary Artery Pseudoaneurysm in an 85-Year-Old Male Hemodialysis Patient: A Surgical Case Report.

BACKGROUND Coronary artery pseudoaneurysm is an extremely rare condition. In this report, we describe an 85-year-old hemodialysis male patient who developed a coronary artery pseudoaneurysm due to physical damage associated with coronary artery calcification. CASE REPORT An 85-year-old man on hemodialysis had undergone emergency percutaneous coronary intervention of the left anterior descending artery for acute coronary syndrome 9 years ago. He presented to the emergency room with a fever and chest pain and was admitted to the cardiology department with a urinary tract infection and acute coronary syndrome. On day 21 after admission, when the urinary tract infection had resolved, coronary angiography was performed, which revealed a pseudoaneurysm proximal to the left anterior descending artery stent. The patient was scheduled to undergo surgery due to the pseudoaneurysm's risk of rupture. Surgical manipulation was performed under cardiac arrest using the median sternotomy approach. A highly calcified coronary intima was found inside the pseudoaneurysm, which was completely ruptured on the proximal side of the pseudoaneurysm. The pseudoaneurysm was closed after endarterectomy. A coronary artery bypass graft was also performed in the great saphenous vein graft of the left anterior descending artery. Histopathological examination showed no obvious signs of infection, and a diagnosis of pseudoaneurysm was established. Postoperative contrast-enhanced computed tomography showed patency of the coronary artery bypass graft and no pseudoaneurysm recurrence. CONCLUSIONS Coronary artery pseudoaneurysms are extremely rare, but this case demonstrates that atherosclerotic changes can lead to the formation of a pseudoaneurysm in an elderly hemodialysis patient.