Minimally invasive redo mitral valve surgery without aortic crossclamp

• Published in: Revista brasileira de cirurgia cardiovascular Vol. 28; no. 3; pp. 325 - 330
• Main Authors: Milani, Rodrigo, Brofman, Paulo Roberto Slud, Oliveira, Sergio, Patrial Neto, Luiz, Rosa, Matheus, Lima, Victor Hugo, Binder, Luis Fernando, Sanches, Aline
• Format: Journal Article
• Language: English; Portuguese
• Published: Brazil Sociedade Brasileira de Cirurgia Cardiovascular 01.07.2013
• Subjects: Aged; Cardiology; Cardiopulmonary Bypass; Female; Heart surgery; Heart Valve Diseases - surgery; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - methods; Humans; Hypothermia, Induced - methods; Length of Stay; Male; Middle Aged; Mitral Valve - surgery; Reoperation - methods; Reproducibility of Results; Thoracic Surgery, Video-Assisted - methods; Thoracotomy - methods; Time Factors; Treatment Outcome; Ventricular Fibrillation - physiopathology
• ISSN: 0102-7638; 1678-9741
• DOI: 10.5935/1678-9741.20130051

Reoperations of the mitral valve have a higher rate of complications when compared with the first surgery. With the field of video-assisted techniques for the first surgery of mitral valve became routine, reoperation cases began to arouse interest for this less invasive procedures. To assess the results and the technical difficulties in 10 patients undergoing minimally invasive redo mitral valve surgery. Cardiopulmonary bypass was installed through a cannula placed in the femoral vessels and right internal jugular vein, conducted in 28 degrees of temperature in ventricular fibrillation. A right lateral thoracotomy with 5 to 6 cm in the third or fourth intercostal space was done, pericardium was displaced only at the point of atriotomy. The aorta was not clamped. Ten patients with mean age of 56.9 ± 10.5 years, four were in atrial fibrilation rhythm and six in sinusal. Average time between first operation and reoperations was 11 ± 3.43 years. The mean EuroSCORE group was 8.3 ± 1.82. The mean ventricular fibrillation and cardiopulmonary bypass was respectively 70.9 ± 17.66 min and 109.4 ± 25.37 min. The average length of stay was 7.6 ± 1.5 days. There were no deaths in this series. Mitral valve reoperation can be performed through less invasive techniques with good immediate results, low morbidity and mortality. However, this type of surgery requires a longer duration of cardiopulmonary bypass, especially in cases where the patient already has prosthesis. The presence of a minimal aortic insufficiency also makes this procedure technically more challenging.