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Ann Thorac Surg 2008;86:466-471. doi:10.1016/j.athoracsur.2008.04.050
© 2008 The Society of Thoracic Surgeons
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Yoshikazu Suzuki
Francis D. Pagani
Steven F. Bolling
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Right arrow Valve disease

Original Articles: Adult Cardiac

Left Thoracotomy for Multiple-Time Redo Mitral Valve Surgery Using On-Pump Beating Heart Technique

Yoshikazu Suzuki, MD, Francis D. Pagani, MD, PhD, Steven F. Bolling, MD*

Section of Cardiac Surgery, Department of Surgery, Cardiovascular Center, University of Michigan Health System, Ann Arbor, Michigan

Accepted for publication April 14, 2008.

* Address correspondence to Dr Bolling, Section of Cardiac Surgery, Department of Surgery, Cardiovascular Center, University of Michigan Health System, 5144 Cardiovascular Center, SPC#5864, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5864 (Email: sbolling{at}med.umich.edu).

Presented at the Poster Session of the Forty-fourth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28–30, 2008.

Background: There are limited reports describing multiple-time redo mitral valve surgery using a left thoracotomy approach and on-pump beating heart technique.

Methods: A retrospective review of medical records for 16 patients from March 2002 to June 2007 was performed.

Results: Mean age was 54 ± 17 (mean ± SD) years (8 males). Preoperative mitral valve regurgitation was 3.6 ± 0.6 in 14, and 2 had severe mitral valve stenosis. New York Heart Association symptom class was 2.9 ± 1.0 and ejection fraction was 0.4 ± 0.15 (range, 0.2 to 0.6). Previous cardiac operations were performed twice in 14 and three times in 2 patients with an interval of 4.8 ± 5.5 years since the last. The procedures included repair (5), replacement (8), and re-replacement (3). All were performed through a fifth intercostal space, left posterolateral thoracotomy with the heart beating on cardiopulmonary bypass (32 to 37°C). Left femoral artery or descending thoracic aorta inflow and left femoral vein or left main pulmonary artery venous drainage with vacuum assist were used. Operation time was 221 ± 51 minutes and cardiopulmonary bypass time was 71 ± 27 minutes. Postoperative ventilation time was 10.0 ± 7.7 hours, intensive care unit stay was 2.9 ± 1.9 days, and hospital stay was 6.2 ± 2.4 days. There were two 30-day mortalities and two died late with a follow-up of 30 ± 22 months.

Conclusions: Left thoracotomy using the on-pump beating heart technique is safe, effective, and should be considered for multiple-time redo mitral valve surgery.






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