Redo mitral surgery using the Estech endoclamp

Redo-CABG surgery remains extremely hazardous in the presence of open bypass grafts. In our patients with mitral valve pathology with open and well-functioning bypass grafts, we explored alternative approaches in order to avoid damage to the grafts by extensive dissection and direct clamping of the ascending aorta. The "Estech procedure," which uses the Estech remote access perfusion (RAP) endoclamp catheter (Estech Inc., Danville, CA), was selected for these patients.

From January 1998 to January 2000, 10 patients underwent an Estech procedure for redo mitral surgery. All patients had previous cardiac operations such as coronary artery bypass grafting (CABG) and/or mitral valve procedures. The Estech procedure consisted of an anterior left thoracotomy and peripheral cannulation at femoral site using the Estech endovascular balloon technique. The series was comprised of seven mitral valve replacements, two valve reconstructions, and one closure of a paravalvular leak. One procedure had to be converted to a standard re-sternotomy due to extreme arteriosclerosis of the descending aorta with plaque dislocation at the time of catheter insertion. However, no damage was inflicted to the open bypass grafts.

The follow-up period ranged from six to 30 months and was 100% complete. We encountered one hospital death in our group, which was due to a late post-operative intestinal infarction and multiple organ failure (MOF), and was not procedure related. As expected, morbidity was high in this compromised cohort, but no late death has occurred prior to submission of this article. All survivors progressed to an acceptable NYHA functional class.

The excellent results in this complex patient group inspired us to use the Estech procedure as a standard approach for redo mitral surgery.