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Minimally Invasive CABG Combined With Mitral Valve Repair and Left Ventricle Aneurysm Repair Through Left Anterior Thoracotomy
A 53-year-old man was admitted with a two-month history of anterior myocardial infarction, congestive heart failure, and a New York Heart Association III classification. Echocardiography showed severe mitral insufficiency (Carpentier I, IIIb), left ventricle aneurysm, and left ventricle ejection fraction (EF) 35%. An angiogram showed severe triple vessel disease.
The authors performed coronary artery bypass grafting combined with mitral valve repair and left ventricle aneurysm repair using a minimally invasive approach through the left anterior thoracotomy in the fourth intercostal space. The left internal mammary artery and saphenous vein were harvested. The authors used peripheral cannulation (femoral) for cardiopulmonary bypass (CPB). The aorta was cross-clamped and cold blood cardioplegia was administered every 15-20 minutes. The following distal anastomoses were performed: vein to PDA, vein to OM, and left internal mammary artery to left anterior descending artery (LAD). Then, a 5 cm incision was made in the left ventricle anterior wall parallel to the LAD through the aneurysmal tissues. The mitral valve was exposed and an Alfieri stitch was done between the A2 - P2 segments of the mitral valve leaflets. Then, a left ventricle repair using two layers of endoventricular suture lines with polypropylene 3-0 was performed. The volume of the left ventricle was reduced and the shape was restored. Proximal anastomoses to the aorta with two vein grafts were completed using a side-biting aortic clamp. Cardiopulmonary bypass was weaned and the wound was closed.
The patient was discharged on the fifth postoperative day with EF 40% and no mitral regurgitation.