Minimally Invasive Combined Mitral Valve Surgery And Right Coronary Artery Bypass Graft With Right Internal Thoracic Artery
Jaqueline G. da Rocha e Silva, Martin Moscoso Ludueña, Andreas Kayss, Dieter Kling, Ardawan J. Rastan.
Heart Center Rotenburg, Rotenburg an der Fulda, Germany.
OBJECTIVE: Minimally invasive techniques in mitral valve surgery (MIMVS) and direct coronary artery bypass (MIDCAB) have been previously reported with important benefits as reduced postoperative pain, improved cosmetic results, less blood transfusions requirements, shorter length of stay, and faster return to activities. A right anterior small thoracotomy to approach the right coronary artery (RCA) has also been proposed recently specially in redo CABG and combined surgeries. However the use of Right Internal Thoracic Artery (RITA) to RCA bypass grafting is still limited and the necessity of single lung ventilation for RITA harvesting in patients with mitral valve disease can be challenging. Therefore, we aim to access safety and feasibility of a combined video assisted minimally invasive MVS and arterial revascularization with the RITA to RCA through a right minithoracotomy.
METHODS: From February 2016 to August 2016, 3 patients underwent MIMVS and RITA bypass to the RCA through a right minithoracotomy. Two patients received mitral valve replacement and in-situ RITA to RCA grafting and one patient received mitral valve repair and RITA as free graft to the RCA.
RESULTS: No deaths occurred perioperatively or during early follow-up. Mean age was 73.3 years (range 59-82 years). Mean operation time, cardiopulmonary bypass, and aortic cross-clamp time were 303 ± 29, 161 ±16 and 105 ±13 minutes, respectively. Duration of mechanical ventilation and length of stay on intensive care unit was 19.3 ± 2.9 and 38.6 ± 12.1 hours, respectively. No conversion to sternotomy was required and there was no postoperative myocardial infarction or stroke. One patient developed intraoperatively an aortic intramural haematoma after femoral cannulation and required a right axillary artery cannulation.
CONCLUSIONS: Concomitant Minimally Invasive Port-Access MV surgery and RCA bypass grafting through Right Internal Thoracic Artery can be achieved in selected patients through a right minithoracotomy with good early outcomes.
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