The Role of the Minimally Invasive Beating Heart Technique in Reoperative Valve Surgery

Abstract

Redo valve surgery with an unclamped aorta is feasible, effective, and at least as safe as surgery using cardioplegic arrest. There was, however, no difference in biochemical or clinical outcomes from conventional surgery using aortic clamping and cardioplegic techniques.

Minimally Invasive Port Access Approach for Reoperations on the Mitral Valve

“…Although the field is lacking in long term follow-up data, the postoperative outcomes have been excellent. Inasmuch as this platform continues to play a greater role in MV operations, several centers have now adopted this approach for reoperative cardiac operations as well [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]. In one report of reoperative MV procedures in cases comparing the port access approach with the redo sternotomy approach, the port access group had higher stroke and MV replacement rates, although mortality was similar [4].…”

“…Preoperatively, patients received a careful history and physical examination, including evaluation for peripheral pulses. The operative technique has been previously described [2,3]. All patients underwent preoperative cardiac catheterization with femoral artery runoff.…”

“…Carbon dioxide was continuously insufflated into the chest throughout the procedure. Evaluation of the previously repaired or replaced MV was performed in standard fashion, with repair and replacement techniques performed as previously described [2,3,8].…”

“…M any centers perform minimally invasive mitral valve (MV) operations through a right minithoracotomy approach, with excellent postoperative outcomes, but only some centers have reported their outcomes with this technique in the context of reoperative cardiac operations [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]. Although the overall outcomes support that in selected patients the right thoracotomy approach can be safely adopted in the reoperative situation, many centers have not adopted the minimally invasive approach in this context.…”

Single Femoral Venous Drainage Versus Both Vena Cava Drainage in Isolated Repeat Tricuspid Valve Surgery

“…As for the FV group, there was only one femoral venous cannula used for venous drainage during the CPB. During the operation, the vena cava did not need to be snared when the heart was beating; [7][8][9] in other words, there was no need to dissect the adhesion tissue of the vena cava, which would have increased the operative risk. 5,10) The application of a single venous drainage technique should satisfy the following requirements: (1) there are enough pores in the femoral vein cannula; (2) VAVD controller must be applied; and (3) the top of the femoral vein cannula must reach the SCV.…”