Right mini-thoracotomy approach in patients undergoing redo mitral valve procedure

Abstract

Aim A minimally invasive technique is an attractive option in cardiac surgery. In this study, we present our experience with minimally invasive cardiac surgery (MICS) via right mini-thoracotomy on patients undergoing mitral valve procedure as reoperation. Methods From 2017 until 2019, 20 patients underwent reoperation of the mitral valve through a right-sided mini-thoracotomy. Cardiopulmonary bypass was established through cannulation of the femoral vessels. All patients requiring isolated re-operative mitral valve surgery with suitable femoral vessels for cannulation were included in the study. Patients requiring concomitant coronary artery bypass grafting (CABG) or with peripheral artery disease were excluded. ResultsThe mean age was 65 ± 12 years. The average log. EuroSCORE was 9 ± 5%. Ten patients with severe mitral valve regurgitation (MR) underwent re-repair of the mitral valve. Seven of them were post mitral valve repair (MVR), one was post aortic valve replacement (AVR), one had tricuspid valve repair, and one other patient had CABG before. Ten patients underwent mitral valve replacement due to mixed mitral valve disease (n = 9) or mitral valve endocarditis (n = 1). Eight patients were post MVR and 2 had AVR before. The mean time to reoperation was 7.5 ± 8 years. In-hospital mortality was 5% (n = 1). The mean cross clamp time was 54 ± 26 min. Postoperative echocardiography revealed competent valve function in all cases with mean ejection fraction of 55 ± 9%. The Kaplan-Meier 1-and 2-year survival was 95%. Conclusion The MICS approach for mitral valve reoperation in selected patients seems to be safe and feasible. It is also a surgical option for high-risk patients.

Right minithoracotomy and resternotomy approach in patients undergoing a redo mitral valve procedure

“…However, some of the disadvantages of the minimally invasive technique need to be mentioned. The cannulation of the femoral artery and vein can lead to complications such as retroperitoneal haematoma or dissection of the aorta [ 26 ]. We therefore recommend ultrasound and computer tomography monitoring of the femoral artery preoperatively; these modalities help to identify femoral arteries with small diameters, kinking or severe atherosclerosis.…”

Lessons learned from 10 years of experience with minimally invasive cardiac surgery

“…In this regard, concomitant trans-mitral septal myectomy and MV surgery via RAMT were enrolled in our experience in endoscopic MICS performing 14 cases safely with excellent surgical outcomes ( 17 ). Moreover, the endoscopic MICS approach for MV reoperation in selected high-risk patients seems to be safe and feasible ( 18 ).…”

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

“…Several studies have compared the MS approach with right mini-thoracotomy and right infra-axillary thoracotomy approaches (6)(7)(8) for re-MVS, and a meta-analysis shows that a right anterolateral mini-thoracotomy approach was associated with a significantly reduced number of deaths compared to resternotomy (18). So far, however, there have been limited evaluations of a TT approach for re-MVS.…”

“…The excellent clinical outcomes of a totally thoracoscopic (TT) initial MVS (5) have rekindled our excitement toward the use of this approach in patients with previous MVS. Although several studies have compared the traditional MS approach with other minimally invasive approaches (6)(7)(8), the literature concerning a TT approach for reoperative mitral valve replacement (re-MVR) is limited. Consequently, we sought to evaluate the perioperative and long-term outcomes of patients undergoing a TT re-MVR approach compared with a concurrent cohort who had their procedures completed via resternotomy.…”