Port-access surgery as elective approach for mitral valve operation in re-do procedures

Davide Ricci, Carlo Pellegrini, Marco Aiello, Alessia Alloni, Barbara Cattadori, Andrea M. D'Armini, Mauro Rinaldi, Mario Viganò

Research output: Contribution to journalArticle

Abstract

Background: Re-do mitral valve procedures performed through median sternotomy carry substantial mortality and morbidity. To avoid complications of sternal re-entry and to provide adequate mitral valve exposure, antero-lateral thoracotomy has been suggested by some authors. Methods: From October 1997 to January 2007, 677 mitral valve operations have been performed in our centre using port-access video-assisted right mini-thoracotomy. Among these, 241 (35.6%) were performed on patients who had undergone one or more previous cardiac surgery procedures. Results: Mean cardio-pulmonary bypass time and endo-clamp time were 117 ± 46 min and 71 ± 31 min, respectively. Arterial cannulation was performed either on the ascending aorta, with the endo-direct cannula (112 patients, 46.5%), or peripherally with a femoral artery approach (129 patients, 53.5%). Conversion to median sternotomy was necessary in only two patients (0.8%) due to aortic dissection (one case) and left ventricle free wall rupture (one case). Median intensive care unit stay was 24 h, median mechanical ventilation time was 12 h; median hospital stay was 8 days. Bleeding requiring surgical revision occurred in 12 patients (4.9%). Hospital mortality was 4.9% (12/241 patients). Conclusions: Port-access video-assisted right mini-thoracotomy allows good results in a difficult subset of patients; it allows minimal adhesion dissection, short ICU and hospital stay. In our practice, this technique has become the treatment of choice for mitral valve re-do surgery.

Original languageEnglish
Pages (from-to)920-925
Number of pages6
JournalEuropean Journal of Cardio-thoracic Surgery
Volume37
Issue number4
DOIs
Publication statusPublished - Apr 2010

Keywords

  • Heart valve
  • Minimally invasive surgery
  • Mitral valve
  • Re-operation
  • Thoracotomy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

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