Right minithoracotomy and resternotomy approach in patients undergoing a redo mitral valve procedure. (15th August 2021)

• Record Type: Journal Article
• Authors: Monsefi, Nadejda; Makkawi, Basel; Öztürk, Mahmut; Alirezai, Hossien; Alaj, Eissa; Bakhtiary, Farhad
• Is Part Of: Interactive cardiovascular and thoracic surgery. Volume 34:Number 1(2022)
• Page Start: 33
• Page End: 39
• Publication Date: 2021-08-15
• Subjects: Mitral valve -- Minimally invasive surgery -- Sternotomy -- Video-assisted redo valve procedures; Chest -- Surgery -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; 616.1
• DOI: 10.1093/icvts/ivab228
• Languages: English
• ISSNs: 1569-9293

Abstract

Abstract: OBJECTIVES: A minimally invasive approach via a thoracotomy is an alternative in challenging redo cardiac procedures. Our goal was to present our early postoperative experience with minimally invasive cardiac surgery via a right minithoracotomy (minimally invasive) and resternotomy in patients undergoing a mitral valve procedure as a reoperation. METHODS: From 2017 until 2020, reoperation of the mitral valve was performed through a right-sided minithoracotomy in 27 patients and via a resternotomy in 26 patients. Patients with femoral vessels suitable for cannulation underwent a minimally invasive technique. Patients requiring concomitant procedures regarding the aortic valve were operated on via a resternotomy. RESULTS: The mean age was 66 ± 12 years in the minimally invasive group and 65 ± 12 years in the whole cohort. The average Society of Thoracic Surgeons score was 11 ± 10% in the minimally invasive group and 13 ± 9% in all patients. The majority of the patients underwent reoperation because of severe mitral valve insufficiency (48% and 55%, respectively). The mean time to reoperation was 7 ± 9 years (minimally invasive group). The 30-day mortality was 4% in the minimally invasive group and 11% in the whole cohort. The blood loss was 566 ± 359 ml in the minimally invasive group and 793 ± 410 ml totally. There were no postoperative neurological complications in the minimally invasive group and 1 (2%) in the whole cohort. Postoperative echocardiography revealed competent mitral valve/prosthesis function in all patients. CONCLUSIONS: A minimally invasive approach for a mitral valve reoperation in selected patients is a safe alternative to resternotomy with a low transfusion requirement. Both surgical techniques are associated with good postoperative outcomes. Abstract : The adverse events during redo cardiac surgery procedures, especially in repeat sternotomy, are well known and lead to higher operative risk, postoperative morbidity and mortality [1, 2].