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Fifteen-year experience with minimally invasive approach for reoperations involving the mitral valve

Joseph M Arcidi1, Evelio Rodriguez, Joseph R Elbeery

  • 1Department of Cardiovascular Sciences, East Carolina University, 600 Moye Blvd, Greenville, NC 27858, USA.

The Journal of Thoracic and Cardiovascular Surgery
|August 9, 2011
PubMed
Abstract

Insights

Minimally invasive right thoracotomy is a safe and effective alternative to sternotomy for mitral valve reoperations, reducing mortality and stroke risk. This approach, utilizing fibrillatory or cardioplegic arrest, demonstrates improved outcomes over 15 years.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Minimally Invasive Procedures

Background:

  • Reoperative sternotomy for mitral valve pathology poses significant risks, particularly with prior bypass grafts or aortic valve prostheses.
  • Minimally invasive right thoracotomy with peripheral cannulation offers an alternative strategy to avoid sternotomy risks.

Purpose of the Study:

  • To review cumulative 15-year hospital outcomes of minimally invasive right thoracotomy for mitral valve reoperations.
  • To assess the safety and effectiveness of this approach compared to traditional sternotomy.

Main Methods:

  • A retrospective review of 167 patients undergoing right minithoracotomy for mitral valve reoperations between June 1996 and April 2010.
  • Analysis of patient demographics, previous surgical history, myocardial preservation techniques (fibrillatory arrest vs. aortic clamping/cardioplegia), and robotic assistance.
  • Evaluation of procedural outcomes, including mitral repair rates, concomitant procedures, mortality, stroke, and conversions to sternotomy.

Main Results:

  • Mitral repair frequency increased significantly over time (43% to 72%), especially for native valves (80%).
  • Concomitant procedures, such as atrial fibrillation ablation, also increased (0% to 48%).
  • Thirty-day mortality was 3.0% overall, with 0% reported since 2005. Stroke occurred in 2.4% of patients. Increased NYHA functional class was the only independent predictor of mortality.

Conclusions:

  • Minimally invasive right thoracotomy is an effective strategy for treating mitral valve pathology, successfully avoiding the risks associated with reoperative sternotomy.
  • Both fibrillatory and cardioplegic arrest methods are safe myocardial preservation techniques for this minimally invasive approach.

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