Beating Heart Minimally Invasive Mitral Valve Surgery in Patients with Previous Sternotomy: The Operative Technique and Early Outcomes
Keywords:
beating heart mitral, minimal invasive mitral, redo cardiac surgery
Abstract
Objective: Re-operative mitral valve surgery is increasingly required and can be associated with significant morbidity and mortality. The beating heart minimally invasive mitral valve surgery has a proposed benefit in avoiding the risks of repeat sternotomy, with reducing the need for adhesiolysisand cardioplegia reperfusion injury.We describe our experience with such a technique in patients with previous sternotomy. Methods: A retrospective study was performed and all patients undergoing surgery of mitral valve through a right limited thoracotomy without application of an aortic cross clamp (beating heart) as a redo cardiac surgery between January 2006 and January 2015 were included (n=25). Perioperative data as well as the operative technique are presented. Results: Six patients (24%) had two previous sternotomies and one (4%) had three previous sternotomies. Mitral valve repair was performed in 11 patients (44%). No patient required conversion to median sternotomy. Inotropic support beyond four hours after operation was required in 7 patients (28%). Ventilation time was less than 12 hours in 14 patients (56%) with another 6 patients (24%) extubated within 24 hours after surgery. Postoperative course was complicated with cerebrovascular accident in 2 patients (8%). In-hospital mortality was 4% (n=1). There was no 30-day mortality after discharge. Conclusions: Re-operative mitral valve surgery can be safely performed through a right limited thoracotomy approach on a beating heart while on full cardiopulmonary bypass. The technique can be associated with potentially shorter operation, shorter cardiopulmonary bypass, and a less complicated recovery.
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2017-01-15
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