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Mini-reoperative mitral valve surgery.

A A Vleissis1, S F Bolling

  • 1Heart Institute, St. Vincent Hospital and Medical Center, Portland, Oregon, USA. avlessis@yahoo.com

Journal of Cardiac Surgery
|October 30, 1999
PubMed
Summary
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This study presents a minimally invasive technique for reoperative atrioventricular valve surgery, offering a safer alternative to sternotomy. Patients experienced faster, less painful recovery, making it a preferred method for those with prior sternotomies.

Area of Science:

  • Cardiovascular Surgery
  • Minimally Invasive Cardiac Surgery
  • Valvular Heart Disease

Background:

  • Reoperative atrioventricular valve surgery carries risks of cardiac or bypass graft injury during sternotomy.
  • Standard right thoracotomy avoids sternotomy risks but involves large incisions and potential pulmonary complications.

Purpose of the Study:

  • To evaluate the safety and feasibility of a minimally invasive approach for reoperative atrioventricular valve surgery.
  • To compare outcomes with traditional sternotomy in patients with previous cardiac surgery.

Main Methods:

  • A minimally invasive approach using a 5-10 cm anterior thoracotomy incision in the 5th interspace.
  • Cardiopulmonary bypass via ascending aorta/femoral artery and bicaval cannulae, with systemic cooling to 25°C and fibrillatory arrest.

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  • Performed on 22 patients (mean age 66 years) with 1-4 prior procedures, including mitral valve repair/replacement, tricuspid valve repair, and ASD closure.

    • Main Results:

    • No intraoperative or 30-day mortality observed.
    • Mean ventilation weaning time of 5 hours, with minimal blood transfusion requirements (1.3 units).
    • At 15-month follow-up, survivors improved to NYHA Class I-II, reporting less pain and faster recovery than previous sternotomies.

    Conclusions:

    • The described minimally invasive approach is safe and technically feasible for reoperative atrioventricular valve surgery.
    • This technique has become the preferred method for reoperative atrioventricular valve procedures in patients with a history of sternotomy.