Beating heart minimally invasive mitral valve surgery in patients with previous sternotomy: the operative technique and early outcomes

Abstract

ObjectiveReoperative 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 adhesiolysis and cardioplegia reperfusion injury. We describe our experience with such a technique in patients with previous sternotomy.MethodsA 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.ResultsSix 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 4 hours after operation was required in seven patients (28%). Ventilation time was less than 12 hours in 14 patients (56%) with another six patients (24%) extubated within 24 hours after surgery. Postoperative course was complicated with cerebrovascular accident in two patients (8%). In-hospital mortality was 4% (n=1). There was no 30-day mortality after discharge.ConclusionsReoperative mitral valve surgery can be safely performed through a limited right 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.

Minimally invasive beating heart technique for mitral valve surgery in patients with previous sternotomy and giant left ventricle

“…Resternotomy may also be complicated in patients who had chest radiotherapy or previous sternal wound infections or in patients with vascular structures (ascending aorta, brachiocephalic vein, right ventricle and bypass vessels) that lie directly behind the sternum. Recently minimally invasive beating heart technique for redo cardic surgery had been safely performed successfully [1][2][3][4][5][6][7], which combined the availability and the advantage of a right-sided minithoracotomy approach without resternotomy and beating heart technique without aortic cross-clamping and cardiac arrest. The beating heart technique can interfere with the mechanisms of ischemia-reperfusion injury [8,9] that may be advantageous particularly in patients with poor left ventricular functions [10][11][12][13][14].…”

Minithoracotomy and Beating Heart Strategy for Mitral Surgery in Secondary Mitral Regurgitation

“…Thus, in this subset of patients, avoiding dissection of the ascending without aortic crossclamping (WAC) approach could be performed limiting the risk of aortic and pulmonary artery and graft tissue dissection. [2][3][4][5][6] Moreover, in subsets with secondary MR associated with low ejection fraction (EF), WAC approach has been reported to be effective by preserving myocardial contractility. 7 In this retrospective bicentric study, we evaluate the results of MIMVS-WAC in patients with secondary MR associated with low EF or previous heart surgery.…”

Minimally invasive beating heart technique for redo mitral valve surgery in patients with giant left ventricle

“…Resternotomy may also be complicated in patients who had chest radiotherapy or previous sternal wound infections or in patients with vascular structures (ascending aorta, brachiocephalic vein,right ventricle and bypass vessels) that lie directly behind the sternum. Recently minimally invasive beating heart technique for redo cardic surgery had been safely performed successfully [1][2][3][4][5][6][7], which combined the availability and the advantage of a right-sided minithoracotomy approach without resternotomy and beating heart technique without aortic cross-clamping and cardiac arrest. The beating heart technique can interfere with the mechanisms of ischemia-reperfusion injury [8,9] that may be advantageous particularly in patients with poor left ventricular functions [10][11][12][13][14].…”