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Anterolateral right thoracotomy for mitral valve procedure after previous coronary artery bypass grafting with

M Yoda1, K Minami, D Fritzsche

  • 1Department of Thoracic and Cardiovascular Surgery, Heart Center North Rhine-Westphalia, University of Bochum, 32545 Bad Oeynhausen, Germany. masatakayoda@aol.com

The Journal of Cardiovascular Surgery
|March 11, 2005
PubMed

Insights

This study shows that anterolateral right thoracotomy is a safe and effective approach for mitral valve surgery in patients with prior coronary artery bypass grafting and functioning internal mammary artery grafts, avoiding graft injury and early death.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Cardiac Valve Surgery

Background:

  • Mitral valve procedures following coronary artery bypass grafting (CABG) present significant risks, particularly injury to functioning internal mammary artery (IMA) grafts.
  • The anterolateral right thoracotomy approach offers direct access to the right atrium, minimizing dissection and reducing the risk of IMA graft damage.

Purpose of the Study:

  • To evaluate the safety and efficacy of the anterolateral right thoracotomy technique for mitral valve operations in patients with prior CABG and patent IMA grafts.
  • To assess the operative outcomes and complications associated with this specific surgical approach.

Main Methods:

  • A retrospective review of 13 patients who underwent mitral valve procedures (repair or replacement) between 1993 and 2002 after previous CABG with functioning IMA grafts.
  • The surgical approach utilized was anterolateral right thoracotomy, employing ventricular fibrillation with moderate hypothermia and avoiding cardiopulmonary bypass.

Main Results:

  • No instances of internal mammary artery graft injury or early mortality were observed in the study cohort.
  • Mitral valve repair was performed in 3 patients, and mitral valve replacement in 10 patients.
  • Complications included new-onset arrhythmia (3 patients), renal insufficiency (1 patient), and reoperation for bleeding (1 patient).

Conclusions:

  • The anterolateral right thoracotomy, combined with ventricular fibrillation and moderate hypothermia without cardiopulmonary bypass, is a safe and effective method for performing mitral valve operations in patients with prior CABG and functioning IMA grafts.
  • This technique successfully mitigates the risk of IMA graft injury, a critical concern in this patient population.
Abstract

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