Right anterolateral thoracotomy: an attractive alternative to repeat sternotomy for high-risk patients undergoing reoperative mitral and tricuspid valve surgery

Abstract

BackgroundReoperative cardiac valve surgery via sternotomy is associated with a substantial morbidity and mortality. This study evaluated the right anterolateral thoracotomy for high-risk patients undergoing mitral and tricuspid valve redo procedures.MethodsOut of a series of 173 patients undergoing redo cardiac valve surgery, 24 patients were reoperative via the right anterolateral thoracotomy as the high-risk group on the basis of the proximity of the heart and great vessels to the sternum and the presence and location of patent bypass grafts.ResultsIn all cases, sternotomy was avoided. The mitral valve and tricuspid valve were replaced in 4 and 19 patients and repaired in 1 and 2 patients, respectively. Moreover, left atrial folding was performed in 5 patients. Mortality was 8.3%. All other patients had uneventful outcomes and normal valve function at follow-up.ConclusionsReoperative cardiac valve surgery can be performed safely using the right anterolateral thoracotomy in high-risk patients. It offers enough exposure. It minimizes the need for cardiac dissection, and thus, the risk for injury. Avoiding a high-risk resternotomy increases patients comfort and safety of redo mitral and tricuspid valve surgery.Electronic supplementary materialThe online version of this article (10.1186/s13019-017-0645-x) contains supplementary material, which is available to authorized users.

Simplified, minimally invasive, beating-heart technique for redo isolated tricuspid valve surgery

“…However, as the development of minimally invasive surgery for atrioventricular valves, atrial septal defects, and atrial fibrillation, this technique has also been used in redo surgeries [8,9]. Some centers have reported their experience with minimally invasive tricuspid valve surgery [10][11][12], but the details of surgical techniques (such as arterial inflow, venous drainage, aortic cross-clamping or not, and cooling temperature) varied among different centers. One of the questions requiring attention is whether redo tricuspid valve surgery can be successfully performed in a simplified way.…”

Mitral Valve Surgery via a Right Infra-axillary Thoracotomy in High-Risk Reoperative Patients

“…Second, this incision offers excellent visualization of mitral valve structures in a direct-line view. Moreover, it is easy to learn and practice compared with other minimally invasive approaches, thoracoscopy, or robotic technology [Bolotin 2004, Patel 2017, Cao 2017, Holzhey 2013. It is mostly similar to the median sternotomy.…”

The “Rebirth” of the Right Anterolateral Thoracotomy Approach in Cardiac Surgery

“…The right anterolateral thoracotomy approach was routinely used for atrial septal, mitral valve and tricuspid valve surgeries in the 1970's and 1980's. Currently, it is considered "as a wellaccepted technique" [ 1 ] , despite the almost universal acceptance of conventional sternotomy. The freely MEDLINE search ( Figure 1 ) illustrates the "rebirth" of right thoracotomy and is evident that several groups have been reported their experiences with this surgical approach.…”