Video-assisted mitral valve reoperation through a right minithoracotomy: A single-center experience

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Cardiac Surgery

Background:

• Previous cardiac surgery, particularly sternotomy, increases the complexity and risk of repeat mitral valve procedures.
• Traditional re-operative mitral valve surgery often requires resternotomy, associated with higher morbidity and mortality.

Purpose of the Study:

• To evaluate the outcomes of a minimally invasive mitral valve surgery technique performed without aortic cross-clamping in patients with a history of previous cardiac surgery.
• To assess the safety and efficacy of video-assisted right minithoracotomy for re-operative mitral valve surgery.

Main Methods:

• A consecutive series of 24 patients undergoing mitral valve surgery between January 2015 and December 2018 were included.
• The procedure involved video-assisted right minithoracotomy, femoro-femoral bypass, and cardiopulmonary bypass at 26°C without aortic cross-clamping.
• Mitral valve repair or replacement was performed based on individual patient anatomy and pathology.

Main Results:

• Mitral valve replacement was performed in 50% and repair in 50% of patients.
• The mean ejection fraction was 46.08±6.52%, and the mean age was 61.52±11.48 years.
• Postoperative complications included low cardiac output syndrome (4.1%), renal failure (8.3%), pneumonia (8.3%), stroke (4.1%), and reoperation for bleeding (8.3%). Mean hospital stay was 10.54 days.

Conclusions:

• Minimally invasive mitral valve surgery without aortic cross-clamping is a feasible and safe approach for selected patients with prior sternotomy.
• Video-assisted right minithoracotomy offers an effective alternative to re-sternotomy for re-operative mitral valve surgery, with acceptable complication rates.