Declining Risk of Reoperative Valvular Surgery

Najafi, Hassan; Guynn, Todd; Najafi, Chris; Alden, Tord D.

doi:10.1111/j.1540-8191.1995.tb00598.x

Cited by 10 publications

(4 citation statements)

References 8 publications

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“…Reoperations in cardiac surgery are reported to be associated with an increased risk for morbidity and mortality [ 15 ]. Redo mitral valve surgery is extremely complex technically due to the necessity of re-entering the heart, dense adhesions and difficulties in exposing the valve.…”

Section: Discussionmentioning

confidence: 99%

Right minithoracotomy and resternotomy approach in patients undergoing a redo mitral valve procedure

Monsefi

Makkawi

Öztürk

et al. 2021

Interactive CardioVascular and Thoracic Surgery

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OBJECTIVES A minimally invasive approach via a thoracotomy is an alternative in challenging redo cardiac procedures. Our goal was to present our early postoperative experience with minimally invasive cardiac surgery via a right minithoracotomy (minimally invasive) and resternotomy in patients undergoing a mitral valve procedure as a reoperation. METHODS From 2017 until 2020, reoperation of the mitral valve was performed through a right-sided minithoracotomy in 27 patients and via a resternotomy in 26 patients. Patients with femoral vessels suitable for cannulation underwent a minimally invasive technique. Patients requiring concomitant procedures regarding the aortic valve were operated on via a resternotomy. RESULTS The mean age was 66 ± 12 years in the minimally invasive group and 65 ± 12 years in the whole cohort. The average Society of Thoracic Surgeons score was 11 ± 10% in the minimally invasive group and 13 ± 9% in all patients. The majority of the patients underwent reoperation because of severe mitral valve insufficiency (48% and 55%, respectively). The mean time to reoperation was 7 ± 9 years (minimally invasive group). The 30-day mortality was 4% in the minimally invasive group and 11% in the whole cohort. The blood loss was 566 ± 359 ml in the minimally invasive group and 793 ± 410 ml totally. There were no postoperative neurological complications in the minimally invasive group and 1 (2%) in the whole cohort. Postoperative echocardiography revealed competent mitral valve/prosthesis function in all patients. CONCLUSIONS A minimally invasive approach for a mitral valve reoperation in selected patients is a safe alternative to resternotomy with a low transfusion requirement. Both surgical techniques are associated with good postoperative outcomes.

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Section: Discussionmentioning

confidence: 99%

Right minithoracotomy and resternotomy approach in patients undergoing a redo mitral valve procedure

Monsefi

Makkawi

Öztürk

et al. 2021

Interactive CardioVascular and Thoracic Surgery

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“…To avoid these complications, anterolateral thoracotomy is suggested by some. 9,13,14 A minimally invasive approach via a right minithoracotomy also could present a valuable approach. This article describes our experience with this alternative method.…”

mentioning

confidence: 99%

Minimally Invasive Approach for Redo Mitral Valve Surgery: A True Benefit for the Patient

Onnasch

Schneider

Falk

et al. 2008

Journal of Cardiac Surgery

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Objectives: Redo mitral valve surgery via sternotomy i s associated with a substantial morbidity and mortality. This study evaluated a minimally invasive technique for mitral valve redo procedures. Material and Methods: Out of a series of 394 patients undergoing mitral valve repair or replacement via a right minithoracotomy, 39 patients underwent redo mitral valve surgery (59 -1-13 years, 23 female). Previous cardiac surgeries included 17 patients with mitral valve repair, 6 patients with mitral valve replacement, 3 patients with aortic valve replacement, 2 patients with atrial septa1 defect closure, and 11 patients with coronary artery bypass grafting (CABG). In all cases, femoro-femoral cannulation was performed. The port access technique was applied in patients undergoing redo valve surgery. In patients with prior CABG, t h e operation was performed using deep hypothermia and ventricular fibrillation. Results: In all cases, sternotomy was avoided. The mitral valve was replaced in 20 patients and repaired in 19. Time of surgery and cross-clamp time were comparable with t h e overall series (168 2 73 [redo] vs 168 2 58 min and 52 f 21 [redo] vs 58 2 25 min). Mortality was 5.1%. One patient had transient hemiplegia due t o t h e migration of t h e endoclamp. All other patients had uneventful outcomes and normal mitral valve function at 3-month's follow-up. Conclusion: Redo mitral valve surgery can b e performed safely using a minimally invasive approach in patients with a previous sternotomy. The right lateral minithoracotomy offers excellent exposure. It minimizes the need for cardiac dissection, and thus, t h e risk for injury. Avoiding a resternotomy increases patient comfort of redo mitral valve surgery

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“…Although some authors have shown that the risks of conventional reoperative valve surgery have been decreasing over the past decade [10,11], operative mortality still ranges from 9% to 24% for reoperative aortic valves and up to 14% for simple reoperative mitral valves. With the presence of coronary artery disease this operative mortality is doubled [10] and with two or more prior cardiac operations this operative mortality has been reported to be as high as 23% [12•].…”

Section: Discussionmentioning

confidence: 99%

Minimal access reoperative mitral and aortic valve surgery

et al. 2000

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Minimally invasive cardiac surgery has allowed surgeons to perform valve procedures with a morbidity and mortality comparable with conventional resternotomy approaches while reducing postoperative ventilatory and intensive care unit requirements and overall hospital length of stay. Additionally, patient satisfaction with rapid recovery, earlier return to work, and improved cosmetic results has pushed the pendulum of reoperative valve surgery towards minimally invasive techniques. We reviewed our institutional data consisting of 129 patients requiring reoperative valve surgery over the past 4 years, which was accomplished using these minimally invasive approaches.

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Declining Risk of Reoperative Valvular Surgery

Cited by 10 publications

References 8 publications

Right minithoracotomy and resternotomy approach in patients undergoing a redo mitral valve procedure

Right minithoracotomy and resternotomy approach in patients undergoing a redo mitral valve procedure

Minimally Invasive Approach for Redo Mitral Valve Surgery: A True Benefit for the Patient

Minimal access reoperative mitral and aortic valve surgery

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