| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 1999;68:2243-2247
© 1999 The Society of Thoracic Surgeons
a Division of Cardiac Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
Address reprint requests to Dr Byrne, Division of Cardiac Surgery, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115
e-mail: jgbyrne{at}bics.bwh.harvard.edu
Background. Mitral valve surgery after previous coronary artery bypass grafting presents a challenging problem for the cardiac surgeon. An injury to patent coronary artery bypass grafts, especially internal mammary artery grafts, during reoperation via a redo sternotomy, may be fatal. Therefore, a reliable alternative to the redo sternotomy is desirable to minimize potential injury to internal mammary artery grafts.
Methods. Between February 1987 and October 1998, we performed 59 consecutive mitral valve operations after previous coronary artery bypass grafting surgery (CABG). A total of 24 patients (41%) had functioning internal mammary artery (IMA) grafts and represent the population for this study. No patients were excluded for any reason. Of the 24 patients, 20 (83%) were men. Mean age was 66 ± 13 years (range 41 to 83 years) and the mean duration from CABG was 5.3 ± 3.6 years (range 0.1 to 12 years). Four (17%) had functioning bilateral internal mammary artery grafts. All had 3 to 4+ mitral regurgitation (MR) at the time of mitral valve surgery and the mean preoperative ejection fraction (EF) was 40% ± 14% (range 20% to 74 %).
Results. Twenty-one (88%) patients underwent mitral valve surgery through an anterolateral right thoracotomy and 3 (12%) through a redo sternotomy. Twenty-two (92%) patients, including the 3 patients in whom a redo sternotomy was used, had cannulation of the femoral artery and vein. Two patients required axillary artery cannulation. All 21 patients in whom the mitral valve was approached through a right thoracotomy underwent deep hypothermia (19.6° ± 2.1°C, range 14° to 25°C) without aortic clamping, with a mean duration of CPB of 138 ± 46 minutes (range 65 to 249 minutes). In 18 (75%), the MR was ischemic in origin and in 6 (25%) there was myxomatous degeneration. Nine (34%) required valve replacement and 15 (66%) underwent repair. There were no operative or hospital deaths and all patients were discharged to home or to a rehabilitation facility. There were 4 (17%) major complications. Two patients suffered respiratory failure requiring tracheotomy, 1 patient developed a perioperative MI requiring an intraaortic balloon pump and 1 developed heart block requiring a permanent pacemaker. There were no neurologic, peripheral vascular, bleeding, or wound complications.
Conclusions. Reoperative mitral valve surgery in the setting of functioning IMA grafts, even in the face of depressed LV function, can be done safely and with minimal morbidity.
This article has been cited by other articles:
|
|
 |
|
  Y. Suzuki, F. D. Pagani, and S. F. Bolling Left thoracotomy for multiple-time redo mitral valve surgery using on-pump beating heart technique. Ann. Thorac. Surg., August 1, 2008; 86(2): 466 - 471. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. F. Loulmet, N. C. Patel, J. M. Jennings, and V. A. Subramanian Less invasive intracardiac surgery performed without aortic clamping. Ann. Thorac. Surg., May 1, 2008; 85(5): 1551 - 1555. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. P. Greelish, R. M. Ahmad, J. M. Balaguer, M. R. Petracek, and J. G. Byrne Reoperative Valve Surgery Card. Surg. Adult, January 1, 2008; 3(2008): 1159 - 1174. [Full Text]
|
|
|
|
 |
|
 F. P. Casselman, M. La Meir, H. Jeanmart, E. Mazzarro, J. Coddens, F. Van Praet, F. Wellens, Y. Vermeulen, and H. Vanermen Endoscopic Mitral and Tricuspid Valve Surgery After Previous Cardiac Surgery Circulation, September 11, 2007; 116(11_suppl): I-270 - I-275. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Rathinam, R. Gohil, J. Galea, and B. E. Keogh A Technique for Salvaging a Critical Internal Mammary Artery Bypass Graft Damaged During Resternotomy Ann. Thorac. Surg., October 1, 2005; 80(4): 1530 - 1531. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M.J. Thompson, A. Behranwala, C. Campanella, W.S. Walker, and E.W.J. Cameron Immediate and long-term results of mitral prosthetic replacement using a right thoracotomy beating heart technique Eur. J. Cardiothorac. Surg., July 1, 2003; 24(1): 47 - 51. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. G. Byrne, B. J. Phillips, and L. H. Cohn Reoperative Valve Surgery Card. Surg. Adult, January 1, 2003; 2(2003): 1047 - 1056. [Full Text]
|
|
|
|
|
|
J. G. Byrne, A. N. Karavas, F. Filsoufi, T. Mihaljevic, L. Aklog, D. H. Adams, L. H. Cohn, and S. F. Aranki Aortic valve surgery after previous coronary artery bypass grafting with functioning internal mammary artery grafts Ann. Thorac. Surg., March 1, 2002; 73(3): 779 - 784. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. L. Holman, S. P. Goldberg, L. J. Early, D. C. McGiffin, J. K. Kirklin, D. H. Cho, and A. D. Pacifico Right thoracotomy for mitral reoperation: analysis of technique and outcome Ann. Thorac. Surg., December 1, 2000; 70(6): 1970 - 1973. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. G. Byrne, A. N. Karavas, D. H. Adams, L. Aklog, S. F. Aranki, G. S. Couper, R. J. Rizzo, and L. H. Cohn Partial upper re-sternotomy for aortic valve replacement or re-replacement after previous cardiac surgery Eur. J. Cardiothorac. Surg., September 1, 2000; 18(3): 282 - 286. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
