Minimally invasive right thoracotomy approach for mitral valve surgery in patients with previous sternotomy: A single institution experience with 173 patients

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 148; no. 6; pp. 2763 - 2768
• Main Authors: Murzi, Michele, MD, Miceli, Antonio, MD, PhD, Di Stefano, Gioia, MD, Cerillo, Alfredo G., MD, Farneti, Pierandrea, MD, Solinas, Marco, MD, Glauber, Mattia, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2014
• Subjects: Aged; Aged, 80 and over; Cardiac Surgical Procedures - adverse effects; Cardiac Surgical Procedures - methods; Cardiac Surgical Procedures - mortality; Cardiopulmonary Bypass; Cardiothoracic Surgery; Female; Humans; Italy; Male; Middle Aged; Minimally Invasive Surgical Procedures; Mitral Valve - surgery; Operative Time; Postoperative Complications - mortality; Postoperative Complications - therapy; Reoperation; Retrospective Studies; Sternotomy - adverse effects; Sternotomy - mortality; Thoracotomy - adverse effects; Thoracotomy - mortality; Time Factors; Treatment Outcome; Italy; MIMVS; 35; OR; minimally invasive mitral valve surgery; 28; CI; hazard ratio; confidence interval; HR; odds ratio
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2014.07.108

Objective This study presents a review of our experience with minimally invasive mitral valve surgery (MIMVS) in patients with a previous cardiac procedure performed through a sternotomy over a 10-year period. Methods From November 2003 to August 2013, 173 patients (age 61.3 ± 12.4 years) underwent reoperative MIMVS through a right minithoracotomy. Previous operations were coronary artery bypass grafting (n = 49; 28.6%), a mitral valve procedure (n = 120; 70.1%), an aortic valve procedure (n = 32; 18.7%), and other operations (n = 14; 8.1%). The mean euroSCORE was 11.2 ± 3.8. The time to redo surgery was 6.9 ± 4.2 years. Results Procedures were performed with central aortic cannulation in 55 patients (31.7%) and peripheral cannulation in 118 (68.3%). A transthoracic clamp was used in 58 patients (33.5%), an endoaortic balloon in 72 (41.6%), hypothermic ventricular fibrillation in 23 (13.2%), and beating heart in 20 (11.5%). Mean cardiopulmonary bypass and crossclamp times were 160 ± 58 minutes and 82 ± 49 minutes, respectively. Mitral repair was performed in 53 patients (30.6%). Forty-three patients (24.7%) had an additional cardiac procedure. Conversion to sternotomy was necessary in 2 patients (1.1%) and reoperation for bleeding in 11 patients (6.3%). Thirty-day mortality was 4.1% (n = 7). Major morbidities included stroke (n = 11; 6%) and new-onset dialysis requirement (n = 4; 2.3%). The mean blood transfusion requirement was 1.4 ± 1.1 units. Mean follow-up was 3.3 ± 2.6 years. Survival at 1, 5, and 10 years was 93.1% ± 1.9%, 87.5% ± 2.7%, and 79.7% ± 3.8%, respectively. Conclusions Reoperative mitral valve surgery can be safely performed through a right minithoracotomy with good early and late outcomes. The avoidance of extensive surgical dissection, optimal valve exposure, and low blood transfusion are the main advantages of this technique.