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Miami Minimally Invasive Valves
Joseph Lamelas, MD
Dedicated to the Advancement of Minimally Invasive Cardiac Surgery
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IHSS

I have performed a total of 35 minimally invasive MVRepairs with an anterior leaflet augmentation for multiple different pathologies including rheumatic disease. severe MAC, radiation valvulopathy, and severe SAM with IHHS.

33 have been with bovine pericardium, 1 with untreated autologous pericardium and 1 with CardioCel.  I have not used CorMatrix because of the multiple reports claiming that on the left side of the heart, there can be a disruption of the patch.  I cannot personally attest to this since I have only used it once on a tricuspid valve reconstruction.

The last of the 35 cases that I performed an anterior leaflet augmentation was with CardioCel.  I found it very comfortable to work with.  It is very flexible and soft and it is easy to pass a 5-0 needle through it. A  saline test of the valve can be performed with this material as opposed to bovine pericardium which is very stiff and competency of the repair can only be assessed once the heart is beating.

I think this will be my go to patch for now and would like to eventually compare its results with the bovine pericardial cases. Of note, I have been told that all of the bovine pericardial patches will eventually calcify but I have not seen that yet since my follow up is not long enough.

I have enclosed pictures.  All of my cases have been performed via a right lateral mini thoracotomy. I truly believe that the visualization is superior to a sternotomy in addition to the fact that a more extensive and complete myectomy can be performed via the mitral valve.

 

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I have enclosed a link to the Annals of Cardiothoracic Surgery.
I have submitted 4 publications to this journal that I would like for all of you to review.
Two are relevant to Minimally Invasive AVR/MVR, one on Minimally Invasive AVR, and one on Building a Minimally Invasive Valve Program, of which I was a co-author with Dr. Tom Nguyen.
In addition, I think that all of the contributions to this journal are significant and will help advance the subspecialty of minimally invasive valve surgery.
I urge all to subscribe.
There are previous editions of this journal which are excellent and I believe serve as a reference for all Cardiothoracic Surgeons.
www.annalscts.com

I truly believe that the easiest way to perform a septal myectomy is through the mitral valve. The majority of cases that have severe MR secondary to SAM and septal hypertrophy will have a small anterior leaflet. There have been reports describing the detachment of the anterior leaflet chords and elongating them with artificial gortex neochordae to eliminate the SAM. I am sure this can be done but there is a more consistent solution. With SAM, MR and septal hypertrophy, I believe that detaching the anterior leaflet and extending the leaflet incision past the commisures, performing a septal myectomy and then suturing a pericardial patch to the defect in the anterior leaflet will resolve the problem. When performing the septal myectomy, I usually take a 3-0 silk needle and drive it into the thickened septum pull it down. Thereafter and 11 blade is used to incise the septum 3-4 mm from the aortic annulus. I will then use the long shafted metsenbaum scissor to complete an extensive myectomy. You can usually take more that you think. This approach will allow you to go deep into the septum towards the apex.
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