Port-access surgery as elective approach for mitral valve operation in re-do procedures

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Cardiac Surgery
• Thoracic Surgery

Background:

• Redo mitral valve surgery via median sternotomy is associated with high mortality and morbidity.
• Antero-lateral thoracotomy is an alternative approach to avoid sternal re-entry complications and improve mitral valve exposure.

Purpose of the Study:

• To evaluate the efficacy and safety of port-access video-assisted right mini-thoracotomy for redo mitral valve surgery.
• To assess outcomes in patients with previous cardiac surgery undergoing minimally invasive mitral valve procedures.

Main Methods:

• A total of 677 mitral valve operations were performed using port-access video-assisted right mini-thoracotomy from October 1997 to January 2007.
• Of these, 241 procedures (35.6%) were on patients with a history of one or more prior cardiac surgeries.

Main Results:

• Mean cardiopulmonary bypass and cross-clamp times were 117±46 min and 71±31 min, respectively.
• Conversion to median sternotomy was required in only 0.8% of cases (n=2).
• Hospital mortality was 4.9% (12/241), with a median ICU stay of 24 hours and median hospital stay of 8 days.

Conclusions:

• Port-access video-assisted right mini-thoracotomy provides favorable results in high-risk patients undergoing redo mitral valve surgery.
• This technique facilitates minimal adhesion dissection and shorter ICU and hospital stays.
• The procedure has become the preferred method for redo mitral valve surgery in this center.