Mitral valve reoperation under ventricular fibrillation through right mini-thoracotomy using three-dimensional videoscope

Abstract

BackgroundConventional reoperative mitral valve surgery by median sternotomy has several difficulties. We performed mitral valve replacement (MVR) under ventricular fibrillation (VF) through right mini-thoracotomy with three-dimensional videoscope for avoiding the problems.MethodsBetween 2006 and 2011, we performed 257 cases of MVR, in which 125 cases underwent isolated MVR. Ten cases of patients underwent reoperative MVR under VF through thoracotomy with three-dimensional videoscope (Group I), and 27 cases of patients underwent reoperative conventional MVR through median sternotomy (Group II). We retrospectively reviewed the outcomes and compared Group I with Group II. Preoperative left ventricular ejection fraction (LVEF) was significantly lower (50.5 ± 19.8% vs 64.4 ± 12.0%; p = 0.046), and significantly higher Euro SCORE was found in Group I (4.8 ± 2.0 vs 3.8 ± 2.4; p = 0.037).ResultsAlthough Group I required cooling and rewarming time, average operative times was significantly shorter in Group I (262 ± 46 min vs 300 ± 57 min; p = 0.044), and cardiopulmonary bypass times and average VF times in Group I and aortic cross-clamp times in Group II were equivalent. There was no significant difference in the average of postoperative maximum creatine kinase (CK)-MB. In-hospital mortality was 0/10 (0%) and 1/27 (3.7%), and postoperative paravalvular leakage occurred in 0/10 (0%) and 1/27 (3.7%), and stroke occurred in 1/10 (10%) and 1/27 (3.7%) for Groups I and II. Two patients underwent reoperation for bleeding in Group II. Intensive care unit stay in Group I was significantly shorter than in Group II (1.8 ± 0.6 days vs 3.0 ± 1.7 days; p = 0.025).ConclusionsThe higher risk of preoperative background in Group I had no effect on the operation. Mitral valve surgery under VF through right mini-thoracotomy can be an alternative procedure for reoperation after conventional various cardiothoracic surgeries.

Long-term outcomes of a totally thoracoscopic approach for reoperative mitral valve replacement: a propensity score matched analysis

“…A recent study by Romano showed that the beating-heart technique is as safe as the arrested-heart technique, with less blood transfusion and lower ventilator times (22). Hiraoka et al performed 10 cases of re-MVR under VF by thoracotomy with a threedimensional videoscope in 2013, and their early experience suggested that the procedure was acceptable as an effective alternative (23). Results of our study confirmed this conclusion.…”

Is Minimally Invasive Mitral Valve Surgery Inappropriate for Redo-surgery or Elderly Patients? – Study of 55 Consecutive Cases Following Minimally Invasive Mitral Valve Replacement Via Right Mini-thoracotomy

“…Furthermore, the rates for freedom from stroke events and reoperation for bleeding were nearly 0%. In addition, 3 other retrospective observational studies all demonstrated the superiority of an RT approach as compared to a median sternotomy for reoperative mitral valve surgery, with excellent results noted in those cases (Table 5) [16][17][18]. Pooled analysis showed a mini-thoracotomy mitral valve surgery procedure as a safe alternative to a standard sternotomy, with reduced mortality rates, length of hospital stay, and reoperations for bleeding, along with a comparable risk of stroke.…”

Mitral valve replacement via a left thoracotomy in dextrocardia and situs solitus

“…However, we as well as others have reported mitral valve replacement or repair under ventricular fibrillation or even on a beating heart. 5 We therefore decided to go for femoral cannulation and to perform the surgery under ventricular fibrillation.…”