Endoscopic Approach Is A Safe Alternative To Redo Sternotomy For Mitral And Tricuspid Valve Re-operations.
Gunaratnam Niranjan, Charlene Tennyson, Ahmed Habib, Palaniqumar Saravanan, Andrew Knowles, Grzegorz Laskawski, Joseph Zacharias.
Blackpool Victoria Hospital, Blackpool, United Kingdom.
Background Increasing numbers of patients are being referred for mitral valve and/or tricuspid valve surgery following previous cardiac surgery. These patients’ are usually older with significant co-morbidities and increased surgical risks. Endoscopic minimally invasive (EMI) via a right mini-thoracotomy gives an alternative approach to redo sternotomy (RS). We present our concurrent experience of redo mitral and/or tricuspid surgery via both approaches Methods All patients between 2007 and 2018 undergoing redo cardiac surgery requiring mitral and/or tricuspid surgery were included. The data was analysed retrospectively using a prospectively collected database. 132 patients were eligible, 87 and 45 in the RS and EMI group respectively. Statistical analysis was performed using Student t-test, Chi˛, Mann-Whitney and Kaplan Meier. Results The patients were well matched for gender distribution (Males, RS 56% v 53%,p=0.74). Patients were significantly older in the EMI group (68.4±10.7v 64±12.9,p=0.049). There was no difference in the groups for preoperative respiratory, neurological, PVD and renal disease, as well as diabetes, arrhythmias and NYHA≥3. There was a greater number of urgent/emergency cases in the RS group (29%v6%,p=0.005). The mean logistic euroscore was similar (RS 12.49v13.52,p=0.17) Bypass and cross clamp times were significantly lower in the EMI group (BPT: EMI 164(46) v 187(84),p=0.046. XCT: 99.3(34.3) v 122.6(58.2),p=0.001). Ventilation times and ITU stay were lower in the EMI group but not significantly. Postoperative blood loss was significantly lower in the EMI group (EMI 210(140-310) v 420(265-655),p<0.001). Red blood cell transfusion was not significantly different but Platelet and FFP transfusion was significantly lower in the EMI group. Pulmonary complications were significantly higher in the RS group (29%v9%,p=0.009), as were new postoperative arrhythmias (36%v9%,p=0.001) and gastrointestinal complications (10%v0%,p=0.026). Total hospital stay was significantly lower in the EMI group (7.5(6-9) v 11(7-19),p=0.0015). In hospital mortality was 9% in both groups (p=0.28). Long term actuarial survival were similar (EMI 7.2v7.8 years,p=0.982). Conclusions Our study revealed the EMI approach for redo cardiac surgery had favourable outcomes. Intraoperative bypass and cross clamp times were significantly lower despite the potential impact of learning curves. Ventilation times and ITU stay were shorter with hospital stay being significantly shorter. Long term survival was similar.
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