Right mini-thoracotomy approach in patients undergoing redo mitral valve procedure
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ORIGINAL ARTICLE
Right mini-thoracotomy approach in patients undergoing redo mitral valve procedure Nadejda Monsefi 1 & Mahmut Öztürk 1 & Tunjay Shavahatli 1 & Farhad Bakhtiary 1 Received: 26 February 2020 / Revised: 22 July 2020 / Accepted: 28 July 2020 # Indian Association of Cardiovascular-Thoracic Surgeons 2020
Abstract Aim A minimally invasive technique is an attractive option in cardiac surgery. In this study, we present our experience with minimally invasive cardiac surgery (MICS) via right mini-thoracotomy on patients undergoing mitral valve procedure as reoperation. Methods From 2017 until 2019, 20 patients underwent reoperation of the mitral valve through a right-sided mini-thoracotomy. Cardiopulmonary bypass was established through cannulation of the femoral vessels. All patients requiring isolated re-operative mitral valve surgery with suitable femoral vessels for cannulation were included in the study. Patients requiring concomitant coronary artery bypass grafting (CABG) or with peripheral artery disease were excluded. Results The mean age was 65 ± 12 years. The average log. EuroSCORE was 9 ± 5%. Ten patients with severe mitral valve regurgitation (MR) underwent re-repair of the mitral valve. Seven of them were post mitral valve repair (MVR), one was post aortic valve replacement (AVR), one had tricuspid valve repair, and one other patient had CABG before. Ten patients underwent mitral valve replacement due to mixed mitral valve disease (n = 9) or mitral valve endocarditis (n = 1). Eight patients were post MVR and 2 had AVR before. The mean time to reoperation was 7.5 ± 8 years. In-hospital mortality was 5% (n = 1). The mean cross clamp time was 54 ± 26 min. Postoperative echocardiography revealed competent valve function in all cases with mean ejection fraction of 55 ± 9%. The Kaplan-Meier 1- and 2-year survival was 95%. Conclusion The MICS approach for mitral valve reoperation in selected patients seems to be safe and feasible. It is also a surgical option for high-risk patients. Keywords Mitral valve . Minimally invasive surgery . Video-assisted redo valve procedures
Introduction Redo cardiac surgery procedures are associated with increased operative risk and postoperative morbidity and mortality [1]. A minimally invasive approach where possible avoids the need for re-sternotomy and injuries related to re-entry. It also may result in less blood loss and requirement of blood transfusion as well as reduced postoperative morbidity. Advancement of technical settings like the minimally invasive cardiac surgery (MICS) approach without re-sternotomy could be an option to minimize injury to cardiac structures
* Nadejda Monsefi [email protected]
and reduce the operative risk of redo cardiac procedures. Since Carpentier and colleagues introduced the MICS technique for mitral valve procedures using a video-assisted right mini-thoracotomy in 1996, this approach has become more and more popular worldwide [2–5]. Even though it is reported that this approach is associated with less blood transfusion and faster
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