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[Mitral valve replacement through a right thoracotomy, with intact coronary artery bypass grafts]
T Hattori1, A Sakai, N Kuroyama
1Department of Cardiovascular Surgery, Seirei Hamamatsu Hospital, Japan.
Summary
This study details a successful mitral valve replacement using a right thoracotomy approach in a patient with prior coronary artery bypass grafting. The minimally invasive technique facilitated safe surgical access and an uncomplicated postoperative recovery.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Minimally Invasive Cardiac Surgery
Background:
- A 68-year-old male patient with a history of aorto-coronary artery bypass grafting (ACBG) required mitral valve surgery.
- The presence of anteriorly placed, intact coronary artery bypass grafts posed a surgical challenge for standard sternotomy approaches.
Observation:
- A right thoracotomy approach was selected to provide direct access to the mitral valve while preserving the integrity of the existing coronary artery bypass grafts.
- Cardiopulmonary bypass was initiated via femoral artery and bicaval cannulation.
- Continuous retrograde cardioplegia with cold blood was administered to protect the myocardium.
Findings:
- Mitral valve replacement was successfully performed using the right thoracotomy approach.
- Meticulous evacuation of residual air through left ventricular and aortic vents was performed.
- The patient experienced an uneventful postoperative course, indicating successful procedural outcome.
Implications:
- Right thoracotomy is a viable and safe alternative for mitral valve surgery in patients with anteriorly placed coronary artery bypass grafts.
- This approach minimizes the risk of graft injury and may lead to improved patient outcomes.
- Minimally invasive cardiac surgery techniques can be adapted to complex patient anatomies, offering tailored solutions for challenging cases.