Mini-thoracotomy and full-sternotomy approach for reoperative mitral valve surgery after a previous sternotomy

Abstract

OBJECTIVES Right mini-thoracotomy approach may enhance the visualization of mitral valve (MV) visualization during redo MV surgery, thereby minimizing the risk of reoperative median sternotomy. We described the clinical outcomes of redo MV surgery by mini-thoracotomy and full-sternotomy approach. METHODS Of 730 consecutive adult patients who underwent redo MV surgery between 2002 and 2018 at our institution, we identified 380 patients (age: 56.0 [14.8] years) after excluding those who underwent concomitant aortic valve or coronary artery surgeries. RESULTS The clinical outcomes in patients who underwent mini-thoracotomy (MINI group; n = 168) and full-sternotomy (STERN group; n = 218) were described. The early and overall mortality in the MINI group was 4.3% (7/162) and 17.3% (28/162), with the rates of early major complications as follows: low cardiac output syndrome, 5.6% (9/162); early stroke, 6.8% (11/162); new-onset dialysis, 6.2% (10/162); prolonged ventilation, 15.4% (25/162); and postoperative bleeding requiring exploration, 7.4% (12/162). In the STERN group, the early mortality was 11.0% (24/218), whereas the risk of low cardiac output syndrome, early stroke, new-onset dialysis, prolonged ventilation, and postoperative bleeding was 12.4% (27/218), 14.2% (31/218), 17.0% (37/218), 33.0% (72/218), and 10.1% (22/218), respectively. The duration of intensive care unit and hospital stay was 2.0 [range 1.0, 3.0] and 8.0 [6.0, 13.0], respectively, in the MINI group and 3.0 [2.0, 7.0] and 14.0 [8.0, 29.0], respectively, in the STERN group. CONCLUSIONS Mini-thoracotomy may be a viable alternative to conventional sternotomy for redo MV surgery.

Mini-access ascending aorto-bifemoral bypass surgery for the treatment of aortic steno-occlusive disease

“…The study results should be interpreted with caution because they are derived from a high-volume, tertiary referral cardiovascular surgical center that has been highly specialized in minimally invasive surgery for not only valvular diseases but also aortic lesions. 13 , 15 , 16 Therefore, the results may not be generalizable to other settings, and there should be steep learning curves to achieve sufficient levels to handle meticulous procedures within limited exposure. In addition, we believe the number of surgical cases shared in the present article is not small given the rarity of illness; however, the experiences should be verified by larger data.…”

Minimally Invasive Procedure versus Conventional Redo Sternotomy for Mitral Valve Surgery in Patients with Previous Cardiac Surgery: A Systematic Review and Meta-Analysis

“…A preliminary screening was then conducted based on the title and abstract of each citation, which led to the selection of 61 articles for full-text evaluation based on eligibility criteria. Ultimately, 12 articles, encompassing 4,157 participants, met the criteria and were deemed suitable for inclusion in this meta-analysis [8][9][10][11][12][13][14][15][16][17][18][19]. The full selection process for the relevant studies is illustrated in Fig.…”

“…Risk ratio with 95% CI Ghoneim et al [15] Losenno et al [14] Patel et al [16] Kwon et al [18] Zhang et al [17] Overall Heterogeneity: =0.00, I =0.00%, H =1.00 Test of = : Q(4)=2.39, p=0.66 Test of =0: z= 3.68, p=0.00…”