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Correspondence

Minimally Invasive Mitral Valve Surgery After Previous Sternotomy

Department of Cardiovascular Surgery, University of Istanbul, Istanbul Medical Faculty, Istanbul, 80630 Turkey

(Email: onurgokseljet{at}gmail.com).

To the Editor:

We read with the greatest interest the article by Seeburger and coworkers [1] on mitral valve replacement in patients with previous cardiac surgery. They analyzed their surgical results with 181 consecutive patients that underwent a limited right lateral thoracotomy for a mitral valve procedure for a 9-year-long period. We would like to congratulate the authors for their favorable results with a 30-day mortality rate of 6.6%. The rate of neurologic deficit of 5.2% in their cohort is also to be congratulated. We concur with the authors' emphasis that the thoracotomy approach is highly practical, as it allows avoidance from extensive dissection of the mediastinum from adhesions due to a previous sternotomy. It is particularly important in the presence of patent coronary artery grafts, as in the case of 42% of their cohort. Our group has also adopted such a limited thoracotomy approach for mitral and tricuspid valve procedures, or both, for the cases that required a repeat sternotomy. In our experience with 7 patients within the last 2 years (3 patients had previous coronary artery bypass with patent grafts, 4 had undergone previous mitral valve replacement), we observed only a single case of mortality after multiple organ failure in a patient that underwent tricuspid valve replacement in addition to a single case of nonfatal stroke in a patient with a repeat mitral valve replacement. It is noteworthy that our surgical technique differs from Seeburger and coworkers [1] technique in that we avoid aortic dissection and clamping; hence performing the valve procedure on the beating, nonejecting heart at 30°C with selective bicaval venous and femoral arterial cannulation with continous aortic venting. In the case of aortic insufficiency, as the authors mentioned, it may be obligatory to arrest the heart. Meticulous removal of air from the heart is a significant challenge in our technique.

Authors also report a 12.1% rate of reoperation due to bleeding. We have also observed a tendency toward greater chest tube drainage and hematoma, particularly in patients with lung adhesions.

We would like to congratulate the authors for the assesment of their results in a practical manner to determine the type of surgery.

	References

Top References

 

1. Seeburger J, Borger MA, Falk V, et al. Minimally invasive mitral valve surgery after previous sternotomy: experience in 181 patients Ann Thorac Surg 2009;87:709-714.[Abstract/Free Full Text]

This article has been cited by other articles:

				J. Seeburger, M. A. Borger, and F. W. Mohr Reply. Ann. Thorac. Surg., October 1, 2009; 88(4): 1384 - 1384. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Onur S. Goksel Emin Tireli Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Goksel, O. S. Articles by Tireli, E. Search for Related Content PubMed PubMed Citation Articles by Goksel, O. S. Articles by Tireli, E. Related Collections Valve disease Related Article