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Original Articles: Adult Cardiac

Minimally Invasive Mitral Valve Surgery After Previous Sternotomy: Experience in 181 Patients

Heart Center, Leipzig University, Leipzig, Germany

Accepted for publication November 19, 2008.

^_* Address correspondence to Dr Seeburger, Heart Center, Leipzig University, Struempelstrasse 39, Leipzig, 04289, Germany (Email: j.seeburger{at}web.de).

Objective: This study evaluated the results for minimally invasive mitral valve (MV) surgery in patients who had undergone previous cardiac operations through a sternotomy.

Methods: From March 1, 1999 to January 2008, minimally invasive MV reoperations were performed in 181 consecutive patients (110 men) with a mean age of 64.5 ± 12 years. A right-sided lateral minithoracotomy with femoral cannulation for cardiopulmonary bypass (CPB) was used. The principal indication was symptomatic severe mitral regurgitation (mean grade, 3.0 ± 0.8). Previous procedures were isolated coronary bypass grafting (CABG) in 76 (42%), isolated valve operation, 55 (30%); combined CABG and valve, 16 (9%); and other cardiac operations, 34 (19%). MV replacement was previously performed in 19 patients and MV repair in 31. Mean preoperative left ventricular ejection fraction was 0.54 ± 0.16.

Results: MV repair, including repeat repair, was performed in 109 patients (60%) and MV replacement in 72 (40%). Operations were performed during ventricular fibrillation in 140 (77%), and a transthoracic aortic cross-clamp was used in 31 (17%). Ten patients (6%) underwent beating heart operations with CPB support. Mean total operating time was 176 ± 50 min. Mean CPB time was 135 ± 40 min. Thirty-day mortality was 6.6%. Early echocardiographic follow-up revealed excellent valve function in most patients.

Conclusion: A minimally invasive approach is a useful alternative for patients requiring a MV procedure after a previous cardiac operation, particularly in patients with patent coronary bypass grafts or previous aortic valve replacement. Very good perioperative results can be achieved with this method.

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Eugene A. Grossi
Ann. Thorac. Surg. 2009 87: 714. [Extract] [Full Text] [PDF]

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