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OBJECTIVE:
Resternotomy for mitral valve surgery may lead to severe complications with high rates of mordibidity and even mortality in particularly those with previous coronary bypass surgery. Right anterior limited thoracotomy approach allows for adequate surgical exposure with significantly lower risk during dissection particularly in patients with patent internal mammarian graft.
METHODS:
23 patients (18 males, 5 females; median age 63 years; range: 46-73 years)all in NYHA class III or IV status and patent LIMA grafts underwent mitral valve surgery between January 2002 and July 2010. 10 patients were approached through a right thoracotomy with beating heart procedure and normothermic cardiopulmonary bypass (right thoracotomy group), and 13 were approached through a resternotomy with aortic cross-clamping and cardioplegic arrest. The median ejection fraction was 42% (range: 35-68%). Predictors of outcome was determined.
RESULTS:
Transfusion requirements were greater in the resternotomy group. Internal mammarian artery graft injury in two resternotomy patient. Two patients in the resternotomy group expired in the immediate postoperative period in comparison to one patient in the right thoracotomy group experienced a nonfatal stroke resulting in multiorgan failure on 81^st day.
CONCLUSIONS:
In patients with coronary artery bypass graft surgery and functional mammarian artery graft, right anterior thoracotomy incision reduces the risk of injury due to a more secure and simple approach rather than re-sternotomy. In addition, the normothermic heart surgery reduces ischemia-reperfusion injury due to cardioplegia and provides better myocardial protection.