ISMICS 17 Annual Scientific Meeting, 7-10 June 2017, Rome Cavalieri, Rome, Italy
ISMICS 17 Annual Scientific Meeting, 7-10 June 2017, Rome Cavalieri, Rome, Italy
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Minimally invasive approach for reoperation for secondary mitral valve regurgitation after CABG surgery. 5 year follow-up
Jakub P. Staromłyński, Anna Witkowska, Radoslaw Smoczynski, Pawel Stachurski, Zygmunt Kalicinski, Wojciech Sarnowski, Dominik Drobinski, Piotr Suwalski.
Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland.

OBJECTIVE:
In recent years due to many factors the number of late reoperations. Especially mitral valve insufficiency has been growing rapidly. These group of patients has been a challenge both for a surgeon and the whole medical care. Minimally invasive approach was described to provide a number of advantages in primary surgery. We analyzed minimally invasive approach as a reoperation in patients with secondary mitral valve regurgitation after previous cardiac surgery.
METHODS:
Between November 2011 and January 2016 in 250 patients, mainly for mitral valve repair, a minimally invasive approach via minithoracotomy was performed. In 16 patients with secondary mitral valve regurgitation as a reoperation after previous cardiac surgery was performed. The surgical access was via right lateral minithoracotomy with the use of extracorporeal circulation via femoral vessels.
RESULTS:
Mean (SD) age was 62.9±11.5 years. Preoperative comorbidities included insulin-dependent diabetes mellitus in 18,1% , chronic renal failure in 18,1%. The mean EF was 48.3±11.2 %. The mean EuroScore II was 14.9± 12.9 %. In this group of patients we did not observe conversion to full sternotomy. The mean CPB was 148.1±79.7min. In this particular group of patients blood transfusion rate was: 1.8±2,3unit. During first 24 hours we observed mean drainage- 427,0±235.2 ml. 10 mitral repair and 6 mitral replacement were performed. One patient died within 30 days observation. We did not observed postoperative bleeding, any stroke or neurological incidents . The mean time of ventilation was 54,9±91.8 hours. There was no wound infection, neurological and vascular complications.. In 5 follow-up up to five years 60±1,7% patients alive with normal echocardiographical findings and NYHA class I to II. In this group we did not observed recurrence of mitral valve disorder.
CONCLUSIONS:
Minimally invasive approach for reoperation for secondary mitral valve regurgitation after previous cardiac surgery is safe, feasible and effective method.


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