International Society For Minimally Invasive Cardiothoracic Surgery

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Minimally Invasive Valve Replacement In Redo Cases
Fatih Gumus, Mehmet Cakici, Evren Ozcinar, Cagdas Baran, Ali Ihsan Hasde, Mustafa Sirlak, Kemalettin Ucanok, Mustafa Serkan Durdu.
Ankara University, ankara, Turkey.

Background:Advance technological improvement has facilitated the implementation of minimally invasive approaches in cardiac surgery even for redo interventions. Redo heart valve surgeries via sternotomy are associated with substantial morbidity and mortality. This study evaluated the minimally invasive technique for heart valves implantation in patients undergoing redo cardiac surgery.METHODS:385 patients underwent aortic, mitral and/or tricuspid valve repair or replacement via a right minithoracotomy between June 2013 and December 2018 in our center, 45 patients underwent redo valve surgery using a minimally invasive approach. Previous cardiac surgeries included 14 patients with aortic and mitral valve replacement and 19 patients with coronary artery bypass grafting (CABG), 12 patients with mitral valve repair or replacement. In all cases, femoro-femoral cannulation was performed. 3D-video assisted access technique was applied in all patients concomitantly. Most of the operation was performed using normothermia cardiopulmonary arrest except in the cases with isolated tricuspid valve repair or replacement and isolated mitral valve repair (n=5) in whom the aortic valve competence was normal. In addition, continuous carbon dioxide is used, and adequate de-airing is monitored by transesophageal echocardiography. RESULTS:In all cases, a sternotomy was avoided. The mitral valve was replaced in 20 patients and repaired in 19. The outcomes of patients (in-hospital mortality about 1.55%) are encouraging and intraoperative times are highly competitive with published data on the standard full sternotomy. Time of surgery and cross-clamp time were compared with the overall series (168+/-73 [redo] vs 168+/-58 min and 52+/-21 [redo] vs 58+/-25 min. Two patients had transient hemiplegia due to air embolism. All other patients had uneventful outcomes and normal valve function at first-year follow-up.CONCLUSIONs:Redo valve surgery can be performed safely using a minimally invasive approach in patients with a previous sternotomy. The right anterior or lateral minithoracotomy offers excellent exposure. It minimizes the need for cardiac dissection, and thus, the risk for injury. Avoiding a resternotomy increases patient comfort of redo mitral valve surgery.

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