Late redo-port access surgery after port access surgery

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Cardiac Surgery
• Valvular Heart Disease

Background:

• Previous port access surgery (PAS) for mitral and tricuspid valve (MV/TV) disease necessitates evaluation of redo procedures.
• Redo-PAS-PAS is an emerging technique for managing new or recurrent MV/TV pathologies after prior minimally invasive surgery.

Purpose of the Study:

• To report the initial short- and long-term outcomes of redo-port access surgery after previous port access surgery (redo-PAS-PAS).
• To evaluate the safety and efficacy of redo-PAS-PAS for mitral and tricuspid valve disease.

Main Methods:

• A consecutive series of 26 patients undergoing redo-PAS-PAS between 1997 and 2014 were analyzed.
• Indications included MV prosthesis dysfunction, endocarditis, and TV dysfunction, with a mean interval of 70.3 months between surgeries.

Main Results:

• Redo-PAS-PAS procedures involved MV replacement (73.1%), MV repair (19.2%), and TV repair (7.7%).
• Sternotomy conversion occurred in 19.2% of cases. Mean cardiopulmonary bypass and cross-clamp times were 163.3 and 101.2 minutes.
• Five-year survival was 83.9%, freedom from reintervention was 95.8%, and 91.3% of survivors were NYHA class II or less, with favorable echocardiographic results.

Conclusions:

• Redo-PAS-PAS is a routine and favorable strategy for patients requiring repeat MV/TV surgery after prior port access procedures.
• The approach offers favorable predicted mortality, morbidity, patient satisfaction, and long-term outcomes.