Takashi Miura1, Kazuyoshi Tanigawa2, Seiji Matsukuma2, Ichiro Matsumaru2, Kazuki Hisatomi2, Shiro Hazama3, Akira Tsuneto4, Kiyoyuki Eishi2. 1. Department of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan. takashiren@yahoo.co.jp. 2. Department of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan. 3. Department of Cardiovascular Surgery, Sasebo General Hospital, Nagasaki, Japan. 4. Department of Cardiology, Nagasaki University Hospital, Nagasaki, Japan.
Abstract
BACKGROUND: To compare the outcomes of mitral and/or tricuspid valve surgery in patients with previous sternotomy between those who underwent a right thoracotomy and those who underwent re-sternotomy. METHODS: Between October 2009 and May 2015, eighteen patients underwent a right thoracotomy (R group) and 28 underwent re-sternotomy (re-S group). The right thoracotomy was prioritized for previous coronary artery bypass grafting. Follow-up was 100 % complete with a mean follow-up of 1.9 ± 1.5 years for the R group and 2.5 ± 1.4 years for the re-S group (p = 0.2137). RESULTS: Hypothermic ventricular fibrillation was applied in 33.3 % in the R group and in 7.1 % in the re-S group (p = 0.0424). Hospital mortality, the median intensive care unit stay, and the median postoperative hospital stay were 0 % versus 7.1 % (p = 0.5130), 3 days versus 2 days (p = 0.2370), and 28 days versus 29.5 days (p = 0.8043) for the R group versus the re-S group, respectively. Although the rate of major complications was comparable (R group 33.3 % versus re-S group 25.0 %, p = 0.5401), those contents were not equal. Deep sternum infection developed only in the re-S group (3.6 %) and reoperation for bleeding was required only in the R group (11.1 %). No significant difference was observed in the 2-year cardiac-related mortality-free rate (R group 93.3 ± 6.4 % versus re-S group 90.8 ± 6.4 %, p = 0.7516). CONCLUSIONS: Given study limitations, the right thoracotomy approach after previous sternotomy provided favorable outcomes as well as re-sternotomy. When selecting a right thoracotomy for re-do mitral and/or tricuspid surgery, the surgical strategy needs to be thoroughly planned.
BACKGROUND: To compare the outcomes of mitral and/or tricuspid valve surgery in patients with previous sternotomy between those who underwent a right thoracotomy and those who underwent re-sternotomy. METHODS: Between October 2009 and May 2015, eighteen patients underwent a right thoracotomy (R group) and 28 underwent re-sternotomy (re-S group). The right thoracotomy was prioritized for previous coronary artery bypass grafting. Follow-up was 100 % complete with a mean follow-up of 1.9 ± 1.5 years for the R group and 2.5 ± 1.4 years for the re-S group (p = 0.2137). RESULTS:Hypothermic ventricular fibrillation was applied in 33.3 % in the R group and in 7.1 % in the re-S group (p = 0.0424). Hospital mortality, the median intensive care unit stay, and the median postoperative hospital stay were 0 % versus 7.1 % (p = 0.5130), 3 days versus 2 days (p = 0.2370), and 28 days versus 29.5 days (p = 0.8043) for the R group versus the re-S group, respectively. Although the rate of major complications was comparable (R group 33.3 % versus re-S group 25.0 %, p = 0.5401), those contents were not equal. Deep sternum infection developed only in the re-S group (3.6 %) and reoperation for bleeding was required only in the R group (11.1 %). No significant difference was observed in the 2-year cardiac-related mortality-free rate (R group 93.3 ± 6.4 % versus re-S group 90.8 ± 6.4 %, p = 0.7516). CONCLUSIONS: Given study limitations, the right thoracotomy approach after previous sternotomy provided favorable outcomes as well as re-sternotomy. When selecting a right thoracotomy for re-do mitral and/or tricuspid surgery, the surgical strategy needs to be thoroughly planned.
Entities:
Keywords:
Minimally invasive valve surgery; Previous standard sternotomy; Reoperation; Right thoracotomy; Standard re-sternotomy
Authors: James S Gammie; Yue Zhao; Eric D Peterson; Sean M O'Brien; J Scott Rankin; Bartley P Griffith Journal: Ann Thorac Surg Date: 2010-11 Impact factor: 4.330
Authors: Robert L Smith; Peter I Ellman; Peter W Thompson; Micah E Girotti; Bret A Mettler; Gorav Ailawadi; Benjamin B Peeler; John A Kern; Irving L Kron Journal: Ann Thorac Surg Date: 2009-03 Impact factor: 4.330
Authors: Volkmar Falk; Davy C H Cheng; Janet Martin; Anno Diegeler; Thierry A Folliguet; L Wiley Nifong; Patrick Perier; Ehud Raanani; J Michael Smith; Joerg Seeburger Journal: Innovations (Phila) Date: 2011-03
Authors: Christian D Etz; Konstadinos A Plestis; Fabian A Kari; Daniel Silovitz; Carol A Bodian; David Spielvogel; Randall B Griepp Journal: Ann Thorac Surg Date: 2008-08 Impact factor: 4.330