Beating Heart Minimally Invasive Mitral Valve Surgery in Patients With Patent Coronary Bypass Grafts

• Published in: Canadian journal of cardiology Vol. 32; no. 8; pp. 987.e1 - 987.e6
• Main Authors: Ghoneim, Aly, MD, Bouhout, Ismail, MD, MSc, Mazine, Amine, MD, MSc, Fortin, William, MD, El-Hamamsy, Ismail, MD, PhD, Jeanmart, Hugue, MD, Pellerin, Michel, MD, Bouchard, Denis, MD, PhD
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 01.08.2016
• Subjects: Acute Kidney Injury - etiology; Aged; Blood Loss, Surgical; Blood Transfusion - statistics & numerical data; Cardiopulmonary Bypass; Cardiovascular; Case-Control Studies; Coronary Artery Bypass; Female; Follow-Up Studies; Heart Valve Prosthesis Implantation; Humans; Male; Middle Aged; Minimally Invasive Surgical Procedures; Mitral Valve - surgery; Mitral Valve Insufficiency - surgery; Postoperative Complications; Sternotomy; Thoracotomy
• ISSN: 0828-282X; 1916-7075
• DOI: 10.1016/j.cjca.2015.09.016

Abstract Background Redo mitral valve surgery in patients with patent coronary bypass grafts carries a risk of graft injury and postoperative bleeding. We compare early results of reoperative minimally invasive on-pump beating heart mitral valve surgery (OPBMS) via mini thoracotomy vs the results of standard sternotomy mitral valve surgery (SSMS) in the presence of patent coronary bypass grafts. Methods Between 2009 and 2015, 12 patients underwent OPBMS through a right mini thoracotomy and 6 patients underwent SSMS. All patients had at least 1 patent bypass graft. Results Median age and EuroSCORE II were not statistically different between the 2 groups. There was no early death in the OPBMS group vs 1 death (17%) in the SSMS group. There was a statistically significant lower median perioperative blood loss in the OPBMS group compared with the SSMS group (200 vs 650 mL; P  = 0.005). Four patients (33%) in the OPBMS group required blood transfusion compared with 4 in the SSMS group (67%; P  = 0.32). There was 1 perioperative stroke (17%) and 1 acute myocardial infarction (17%) in the SSMS group. Four patients developed acute renal failure in the OPBMS group compared with 3 in the SSMS group (50%; P  = 0.62). The predischarge transthoracic echocardiogram showed ≤ 1 mitral regurgitation in all patients. Conclusions Redo mitral surgery in patients with patent bypass grafts can safely be performed via minimally invasive mini thoracotomy on a beating heart. The main benefits of this approach are to avoid the sternotomy and decrease the amount of postoperative blood loss.