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.
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.
Authors: Piroze M Davierwala; Joerg Seeburger; Bettina Pfannmueller; Jens Garbade; Martin Misfeld; Michael A Borger; Friedrich W Mohr Journal: Ann Cardiothorac Surg Date: 2013-11
Authors: Markus Kamler; Daniel Wendt; Unsal Pul; Matthias Thielmann; Thomas Buck; Eva Kottenberg; Raimund Erbel; Heinz Jakob Journal: Herz Date: 2009-09 Impact factor: 1.443
Authors: Martin Misfeld; Michael Borger; John G Byrne; W Randolph Chitwood; Lawrence Cohn; Aubrey Galloway; Jens Garbade; Mattia Glauber; Ernesto Greco; Clark W Hargrove; David M Holzhey; Ralf Krakor; Didier Loulmet; Yugal Mishra; Paul Modi; Douglas Murphy; L Wiley Nifong; Kazuma Okamoto; Joerg Seeburger; David H Tian; Marcel Vollroth; Tristan D Yan Journal: Ann Cardiothorac Surg Date: 2013-11