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

Abstract

OBJECTIVES A minimally invasive approach via a thoracotomy is an alternative in challenging redo cardiac procedures. Our goal was to present our early postoperative experience with minimally invasive cardiac surgery via a right minithoracotomy (minimally invasive) and resternotomy in patients undergoing a mitral valve procedure as a reoperation. METHODS From 2017 until 2020, reoperation of the mitral valve was performed through a right-sided minithoracotomy in 27 patients and via a resternotomy in 26 patients. Patients with femoral vessels suitable for cannulation underwent a minimally invasive technique. Patients requiring concomitant procedures regarding the aortic valve were operated on via a resternotomy. RESULTS The mean age was 66 ± 12 years in the minimally invasive group and 65 ± 12 years in the whole cohort. The average Society of Thoracic Surgeons score was 11 ± 10% in the minimally invasive group and 13 ± 9% in all patients. The majority of the patients underwent reoperation because of severe mitral valve insufficiency (48% and 55%, respectively). The mean time to reoperation was 7 ± 9 years (minimally invasive group). The 30-day mortality was 4% in the minimally invasive group and 11% in the whole cohort. The blood loss was 566 ± 359 ml in the minimally invasive group and 793 ± 410 ml totally. There were no postoperative neurological complications in the minimally invasive group and 1 (2%) in the whole cohort. Postoperative echocardiography revealed competent mitral valve/prosthesis function in all patients. CONCLUSIONS A minimally invasive approach for a mitral valve reoperation in selected patients is a safe alternative to resternotomy with a low transfusion requirement. Both surgical techniques are associated with good postoperative outcomes.

Comparison of Two Surgical Approaches for Coronary Artery Bypass of Left Anterior Descending Artery

“…These technical challenges and concerns about the quality of coronary anastomoses were some of the difficulties described in earlier reports about MIDCAB [ 23 ]. This apparent disparity with our results can then be explained by the maturity of and the recent advances in minimally invasive techniques in cardiac surgeries at our centers [ 5 , 6 , 10 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ]. Although MIDCAB, and other minimally invasive cardiac surgeries, are still relatively uncommon and mainly limited to specialist centers, they have been shown to be a very promising advancement in the field of cardiac surgery, being successfully and safely applied in a broad spectrum of surgical cardiac interventions [ 1 ].…”

Mitral valve surgery via repeat median sternotomy versus right mini‐thoracotomy: A systematic review and meta‐analysis of clinical outcomes

“…6,11 Reoperative MV operations in contemporary practice have shown favorability with careful planning and surgical experience. 5,9,12 There is still an ongoing debate on which surgical approach provides a better outcome for patients undergoing mitral valve surgery after previous cardiac operation.…”

“…8 The right-sided mini-thoracotomy approach is an alternative option to minimize injury to cardiac structures and reduce the operative risk of repeat cardiac surgeries. 9 Right-sided mini-thoracotomy avoids reentry of the sternum and limited dissection of adhesions, it has shown to have lower mortality and fewer cases of major complications. 4,8,10 There have been a few technical options proposed for minimally invasive MV reoperation, for example, cannulation sites and type of cannulae for cardiopulmonary bypass (CPB), use of aortic clamping, endoclamp or continuous coronary perfusion (beating heart or ventricular fibrillation).…”

“…It also provides poor access to the mitral valve due to the presence of dense adhesions 8 . The right‐sided mini‐thoracotomy approach is an alternative option to minimize injury to cardiac structures and reduce the operative risk of repeat cardiac surgeries 9 . Right‐sided mini‐thoracotomy avoids re‐entry of the sternum and limited dissection of adhesions, it has shown to have lower mortality and fewer cases of major complications 4,8,10 .…”

“…There have been a few technical options proposed for minimally invasive MV reoperation, for example, cannulation sites and type of cannulae for cardiopulmonary bypass (CPB), use of aortic clamping, endoclamp or continuous coronary perfusion (beating heart or ventricular fibrillation) 6,11 . Reoperative MV operations in contemporary practice have shown favorability with careful planning and surgical experience 5,9,12 . There is still an ongoing debate on which surgical approach provides a better outcome for patients undergoing mitral valve surgery after previous cardiac operation.…”