Left thoracotomy for multiple-time redo mitral valve surgery using on-pump beating heart technique

There are limited reports describing multiple-time redo mitral valve surgery using a left thoracotomy approach and on-pump beating heart technique.

A retrospective review of medical records for 16 patients from March 2002 to June 2007 was performed.

Mean age was 54 +/- 17 (mean +/- SD) years (8 males). Preoperative mitral valve regurgitation was 3.6 +/- 0.6 in 14, and 2 had severe mitral valve stenosis. New York Heart Association symptom class was 2.9 +/- 1.0 and ejection fraction was 0.4 +/- 0.15 (range, 0.2 to 0.6). Previous cardiac operations were performed twice in 14 and three times in 2 patients with an interval of 4.8 +/- 5.5 years since the last. The procedures included repair (5), replacement (8), and re-replacement (3). All were performed through a fifth intercostal space, left posterolateral thoracotomy with the heart beating on cardiopulmonary bypass (32 to 37 degrees C). Left femoral artery or descending thoracic aorta inflow and left femoral vein or left main pulmonary artery venous drainage with vacuum assist were used. Operation time was 221 +/- 51 minutes and cardiopulmonary bypass time was 71 +/- 27 minutes. Postoperative ventilation time was 10.0 +/- 7.7 hours, intensive care unit stay was 2.9 +/- 1.9 days, and hospital stay was 6.2 +/- 2.4 days. There were two 30-day mortalities and two died late with a follow-up of 30 +/- 22 months.

Left thoracotomy using the on-pump beating heart technique is safe, effective, and should be considered for multiple-time redo mitral valve surgery.