Mitral Valve Surgery via a Right Infra-axillary Thoracotomy in High-Risk Reoperative Patients

Abstract

<jats:p>Background: A right infra-axillary thoracotomy can offer excellent exposure of the mitral valve. This study evaluated this incision for high-risk patients undergoing redo mitral valve procedures.&#x0D; Methods: Of a series of 189 patients who had redo mitral valve surgery, 32 were reoperated via vertical infra-axillary thoracotomy based on previous aortic valve replacement, dense adhesion, location of patent bypass grafts, and peripheral vascular disease.&#x0D; Results: Sternotomy was avoided in all cases. The mitral valve was replaced in 22 patients and repaired in 10 patients; left atrial folding was performed in 6 patients. All patients had uneventful outcomes and normal valve function during follow-up.&#x0D; Conclusions: Reoperative mitral valve surgeries can be performed safely using right infra-axillary thoracotomy in certain patients. The procedure offers excellent exposure of the mitral valve and minimizes the need for cardiac dissection, thus reducing injury risk. Avoiding a high risk of resternotomy increases patient comfort and safety.</jats:p>

Long-term outcomes of a totally thoracoscopic approach for reoperative mitral valve replacement: a propensity score matched analysis

“…Several studies have compared the MS approach with right mini-thoracotomy and right infra-axillary thoracotomy approaches (6)(7)(8) for re-MVS, and a meta-analysis shows that a right anterolateral mini-thoracotomy approach was associated with a significantly reduced number of deaths compared to resternotomy (18). So far, however, there have been limited evaluations of a TT approach for re-MVS.…”

“…The excellent clinical outcomes of a totally thoracoscopic (TT) initial MVS (5) have rekindled our excitement toward the use of this approach in patients with previous MVS. Although several studies have compared the traditional MS approach with other minimally invasive approaches (6)(7)(8), the literature concerning a TT approach for reoperative mitral valve replacement (re-MVR) is limited. Consequently, we sought to evaluate the perioperative and long-term outcomes of patients undergoing a TT re-MVR approach compared with a concurrent cohort who had their procedures completed via resternotomy.…”