Minimally Invasive Mitral Valve Reoperations In Patients With Previous Right Minithoracotomy: First Experience.
Antonio Lio, Antonio Miceli, Matteo Ferrarini, Mattia Glauber.
Cardiothoracic Center, Istituto Clinico Sant'Ambrogio, Milan, Italy.
Objective. Minimally invasive surgery through a right minithoracotomy has been adopted from many centers for the treatment of mitral valve disease. The presence of a previous thoracotomy is considered a contraindication for a minimally invasive approach in case of reoperative mitral valve surgery. The standard sternotomy approach is widely accepted as the first treatment choice in these cases. We describe our first experience of minimally invasive mitral valve reoperations in previous minithoracotomy.
Methods. A retrospective study was undertaken on 18 patients that underwent redo-mitral valve surgery from June 2014 to April 2016. In all patients femoral vessels cannulation was performed. Minithoracotomy was made in the same space of the previous operation. Ascending aorta was directly cross-clamped with a dedicated clamp or an endoclamp was used if strong adhesions were present.
Results. Mean age was 66 ± 7 years and mean logistic EuroSCORE II was 3.8 ± 0.9%. First minimally invasive operation was a mitral valve repair in 16 patients (88%) and mitral valve replacement in 2 (12%). Mean time from first operation was 7 ± 3 years. Direct ascending aorta cross-clamping was possible in 12 patients (66%); in 6 cases (34%) an endoclamp was necessary. Mean CPB and cross-clamp times were 217 ± 17 and 130 ± 11 minutes, respectively. Mitral re-repair was performed in 14 patients (77%). Postoperatively, no patient died. Mean Intensive Care Unit and In-hospital stay were 2 ± 1 and 8 ± 2 days, respectively.
Conclusion. Reoperative mitral valve surgery through a minithoracotomy is a feasible treatment option. Predisposition for endoclamp is reccomended in cases of severe ascending aorta adhesions. Finally, in almost all patients with mitral degenerative disease, a re-repair was performed.
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