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Minimally Invasive Reoperative Surgery is the Preferred Approach after Previous Sternotomy
Anthony Lemaire, Madonna Lee, George Batsides, Aziz Ghaly, Leonard Y. Lee.
Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA.

OBJECTIVE: To determine the Effectiveness of Minimally Invasive surgery for patients with previous sternotomy. The primary endpoints include operative mortality and complication rate.
METHODS: A retrospective review of prospectively collected data from a single institution from July 1st 2011 to December 31st, 2013. The patients underwent aortic valve replacement, mitral valve repair or replacement, and other procedures. Charts were evaluated for demographics, operative details and postoperative outcomes. Operative mortality was defined as death within 30-days of surgery.
RESULTS: The average age of the patients was 71.83 ±14.60 and the majority of the patients were male (N=28). We identified 43 patients who underwent previous sternotomy for open heart surgery and now underwent a mini-sternotomy (N=23) or right thoracotomy (N=20) for surgery. Of the patients, 27 patients had an aortic valve replacement, 11 patients had a mitral valve procedure, and 5 patients had other procedures including an aneurysm repair. The mortality rate was 0% for the entire group and there were no complications. The average length of stay was 12.41±8.93 for the entire group.
CONCLUSIONS: Repeat sternotomy has increased risk for patients undergoing adult cardiac surgery. Our study shows that patients who underwent a minimally invasive approach for open heart surgery after previous sternotomy have great outcomes with no mortality and no complications. Although the risks are enhanced with the proper preparation patients can have successful outcomes.

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