Minimally invasive redo mitral valve surgery without aortic crossclamp

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Techniques
• Mitral Valve Surgery

Background:

• Reoperations for mitral valve disease carry higher complication risks than primary surgeries.
• The increasing prevalence of video-assisted techniques for initial mitral valve surgery has spurred interest in less invasive approaches for reoperations.

Purpose of the Study:

• To evaluate the outcomes and technical challenges associated with minimally invasive mitral valve reoperations.
• To assess the feasibility of less invasive surgical options for patients requiring repeat mitral valve procedures.

Main Methods:

• A cohort of 10 patients underwent minimally invasive redo mitral valve surgery.
• Procedures utilized femoral and jugular vein cannulation for cardiopulmonary bypass at 28°C under ventricular fibrillation.
• A small right lateral thoracotomy was employed, avoiding aortic clamping.

Main Results:

• The study included 10 patients with a mean age of 56.9 years.
• The average time between the first and reoperation was 11 years, with a mean EuroSCORE of 8.3.
• No mortality was observed in this series, with an average hospital stay of 7.6 days.

Conclusions:

• Minimally invasive mitral valve reoperation is feasible, demonstrating good immediate outcomes with low morbidity and mortality.
• This technique necessitates extended cardiopulmonary bypass times, particularly in patients with prior prostheses.
• Pre-existing mild aortic insufficiency can increase the technical complexity of the procedure.