Feasibility And Benefit Of Right Minithoracotomy Approach In Cardiac Surgery In Patients With Previous Sternotomy
Kazuma Okamoto, Ryo Toma, Shinichi Ijuin, Takuya Misato, Taro hayashi, Masahiro Yamaguchi, Satoshi Tobe.
Akashi Medical Center, Akashi, Japan.
OBJECTIVE: Minimally invasive cardiac surgery (MICS) via right minithoracotomy has become one of popular choices for mitral valve surgery and other cardiac surgery. On the other hand, redo cardiac surgery requiring re-sternotomy has higher potential risk. To solve the drawback, we have applied right minithoracotomy MICS for cardiac surgery in patients with previous sternotomy. The feasibility and benefit of right minithoracotomy MICS in cardiac surgery with previous sternotomy was verified by comparison between redo setting (Group R) and primary surgery (Group P).
METHODS: In 113 MICS cases via right minithoracotomy (mitral valve plasty (MVP) 70, mitral valve replacement (MVR) 4, aortic valve replacement (AVR) 5, left atrial myxoma 5, atrial septal defect (ASD) 10), 19 cases (Group R) had previous sternotomy history (MVP 5, MVR 12, thrombus 1, Tricuspid annuloplasty (TAP) 1). In the Group R, on-pump beating surgery without aortic cross clamping was applied to five cases.
RESULTS: In the Group R, no cardiac injury happened during heart exposure. Between two groups (Group R vs P), age (71.1 vs 62.1), EF (57.3% vs 65.8%), left atrial diameter (50.1 vs 42.0) were significantly different preoperatively. Although aortic cross clamping time was same, extra-corporeal circulation time (141.9 min vs 178.2 min) and operative time (295.8 min vs 241.5 min) was significantly longer in the Group R. The units of transfused red blood cells (6.4 U vs 1.6U), fresh frozen plasma (2.9 U vs 1.0 U) and platelet (7.5 vs 1.0) was higher in Group R. In both groups, hospital death occurred in one case respectively (5.3% vs 1.1%). Respirator support time, ICU stay, and hospital stay were significantly longer in Group R. There was no difference in rate of major complication between the two groups (10.5% vs 12.8%).
CONCLUSIONS: Although in patients with previous sternotomy higher amount of medical resources such as blood transfusion and hospital facility were consumed in redo setting, right minithoracotmy approach was feasible and beneficial solution for redo cardiac surgery with previous sternotomy history. Even in redo setting, patients can get advantage of minithoracotomy approach with equivalent risk to primary MICS.
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