Steven R. Meyer, Wilson Y. Szeto, John G.T. Augoustides, Rohinton J. Morris, William J. Vernick, Deborah Paschal, Jeanne Fox, W. Clark Hargrove, III.
University of Pennsylvania, Philadelphia, PA, USA.
OBJECTIVE: Reoperative mitral valve (MV) surgery via sternotomy can be technically challenging. Limited exposure and re-entry injury to the right ventricle or patent grafts (previous CABG) are potential complications. The purpose of this study was to examine the results of port-access MV surgery via right mini-thoracotomy in patients with previous cardiac surgery performed via median sternotomy.
METHODS: From 1998 through July 2007, 651 port access MV procedures were performed. In 107 (16.4%) patients, previous cardiac surgery had been performed. Mean age was 67.5 ± 11.2 years and 60.7% (n=65) were males. Previous surgery included CABG (n=45, 42.1%), aortic valve replacement (AVR; n=9, 8.4%), AVR/ MV repair (n=2, 1.9%), MV repair (n=21, 19.3%), MV replacement (n=5, 4.7%), CABG/MV replacement (n=1, 0.9%), CABG/ MV repair (n=8, 7.8%) and others (n=14, 13.1%). NYHA class were I (n=2, 1.9%), II (n=28, 26.2%), III (n=50, 46.7%), and IV (n=27, 25.2%). The endoaortic balloon and the Chitwood clamp were used in 75 patients (70.1%) and 11 patients (10.2%), respectively. In the remaining patients (n=21, 19.6%), fibrillatory arrest was employed.
RESULTS: MV repair and MV replacement were performed in 47 (43.9%) and 56 (56.1%) patients, respectively. The 30-day mortality was 4.7% (n=5). The mean CPB and aortic crossclamp times were 140.8 ± 43.7 minutes and 77.0 ± 49.7 minutes, respectively. Complications included reoperation for bleeding (n=6, 5.6%), stroke (n=1, 0.9%), and wound infection (n=2, 1.9%). Conversion to sternotomy was required in 1 (0.9%) patient due to an acute type A dissection secondary to aortic occlusion with Chitwood clamp. The mean hospital stay was 11.3 days. In follow up, reoperation for failure of MV repair was performed in 3 (2.8%) patients.
CONCLUSIONS: Reoperative port access MV surgery can be performed with minimal morbidity and mortality. This approach may be the preferred technique in patients who require MV procedures after previous cardiac surgery performed via median sternotomy.
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