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.
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.
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.
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.
Minimally invasive approach for reoperation for secondary mitral valve regurgitation after previous cardiac surgery is safe, feasible and effective method.
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