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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 Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Joerg Seeburger Michael A. Borger Friedrich W. Mohr Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Seeburger, J. Articles by Mohr, F. W. Search for Related Content PubMed Articles by Seeburger, J. Articles by Mohr, F. W. Related Collections Related Article

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Correspondence

Reply

Heart Center, Leipzig University, Struempelstrasse 39, Leipzig, 04289 Germany

(Email: joerg.seeburger{at}med.uni-leipzig.de).

To the Editor:

We have read with great interest the letter from Drs Goksel and Tireli [1] regarding our article [2].

Goksel and Tireli [1] emphasize the importance of tissue adhesions in redo mitral valve cases. Although adhesions around patent coronary bypass grafts or between the right ventricle and sternum can be avoided with the right lateral thoracotomy approach, adhesions between the chest wall and the lungs can occasionally be problematic, particularly with respect to postoperative bleeding. The authors also correctly point out that in those patients with patent coronary bypass grafts, mitral valve surgery can be performed on the beating non-ejecting heart with continuous venting of the ascending aorta. This technique allows optimal myocardial protection and also avoids clamping of the aorta. One problem with this technique, however, is the risk of significant air embolization, particularly near the end of the mitral valve repair when the left ventricle fills and the mitral valve is competent. We have therefore tended to perform these procedures on the fibrillating heart which still allows for good exposure of the mitral valve and a more physiologic assessment of valvular function than with cardioplegic arrest.

We thank Goksel and Tireli [1] for their kind comments. We are convinced that further technical improvements, such as continuous aortic venting, will allow further steps to be made toward an even better treatment regimen for these considerably high-risk patients.

	References

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1. Goksel OS, Tireli E. Minimally invasive mitral valve surgery after previous sternotomy (letter) Ann Thorac Surg 2009;88:1384.[Free Full Text]
2. 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 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 Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Joerg Seeburger Michael A. Borger Friedrich W. Mohr Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Seeburger, J. Articles by Mohr, F. W. Search for Related Content PubMed Articles by Seeburger, J. Articles by Mohr, F. W. Related Collections Related Article