Joerg Seeburger, Volkmar Falk, Thomas Kuntze, Michael Borger, Nicolas Doll, Markus Czesla, Joerg Ender, Friedrich W. Mohr.
Heartcenter Leipzig, Leipzig, Germany.
Objective: The purpose of this study was to evaluate our results for minimally invasive mitral valve (MV) operations in patients with previous cardiac surgery.
Methods: From 03/1999 to 02/2007, operation for MV disease was performed in 151 patients who had previously undergone cardiac surgery. In all patients the minimally invasive approach via a right lateral mini-thoracotomy and femoral cannulation for cardiopulmonary bypass (CPB) was selected. The principal indication for surgery was symptomatic severe mitral regurgitation (mean grade 2.8+/-0.8). A total of 66 patients (44%) underwent previous CABG surgery, 60 patients (40%) isolated valve surgery, 16 (10%) combined CABG and valve, and 9 (6%) other cardiac operations. MV replacement was previously performed in 14 patients and MV repair in 36. The mean age was 64.9+/-11.4 years, and 58% of patients (n=89) were men. Mean preoperative LVEF was 50.5+/-14.9%.
Results: MV repair including re-repair was performed in 58% (n=88) of patients and MV replacement in 42% (n=63). In 79% (n=119) of cases, surgery was performed during ventricular fibrillation and in 17% (n=26) a transthoracic aortic crossclamp could be used. The remaining 4% of patients (n=6) underwent surgery on the beating heart. Mean total operating time was 175+/-50 min and mean CPB time was 134+/-40 min. Early mortality following MV repair was 5.7% (n=5) and therefore much lower than the predicted Euroscore mortality risk of 17.5%. This was also true for the early mortality following MV replacement with 7.9% (n=5) and a predicted Euroscore mortality risk of 19.9%. Follow-up time was 22.5+/-21 months and was 100% complete. Kaplan-Meier estimate for cumulative survival at three years following MV repair was 79.9% (95%CI:67.4-88.5%), and 73.6% (95%CI:60.4-83.6%) following MV replacement. Early and mid-term echocardiographic follow-up revealed excellent valve function in the vast majority of patients.
Conclusion: Minimally invasive MV surgery is safe and effective in patients with previous cardiac operations. The procedure is particularly valuable in patients with patent coronary bypass grafts avoiding the risk of perioperative graft injury. It allows for better exposition of the MV in patients who had previously undergone aortic valve replacement. Medium-term results are very good.
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