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The preferred approach for mitral valve surgery after CABG: right thoracotomy, hypothermia and avoidance of LIMA-LAD graft.
J Heart Valve Dis. 2001 Sep; 10(5):584-90.JH

Abstract

BACKGROUND AND AIM OF THE STUDY

An alternative to avoid redo sternotomy in patients with patent left internal mammary artery-left anterior descending coronary artery (LIMA-LAD) grafts undergoing mitral valve surgery is right thoracotomy with moderate-deep hypothermia (approximately 20 degrees C) and fibrillatory arrest without aortic cross-clamping. Few reports exist which directly compare re-sternotomy and right thoracotomy.

METHODS

Between July 1992 and February 2000, 47 patients (39 males, eight females; median age 66 years; range: 41-83 years; 41 in NYHA class III or IV) with patent LIMA-LAD grafts underwent mitral valve surgery. Thirty-seven patients were approached through a right thoracotomy with moderate-deep hypothermia (median 20 degrees C) and fibrillatory arrest (right thoracotomy group), and 10 were approached through a re-sternotomy, with aortic cross-clamping and cardioplegic arrest. The median ejection fraction was 42% (range: 20-71%). Univariate analysis was used to determine predictors of outcome, as well as to evaluate differences in characteristics between groups.

RESULTS

Operative mortality (OM) and perioperative myocardial infarction for the entire cohort was 11% and 10%, respectively, and there were no inter-group differences. No preoperative characteristics were associated with OM. Two LIMA-LAD graft injuries occurred in the re-sternotomy group compared with none in the right thoracotomy group (20% versus 0%, p = 0.04). Transfusion requirements were also greater in the redo sternotomy group (median 7 versus 2 packed red blood cell units, p = 0.04).

CONCLUSION

Right thoracotomy with moderate-deep hypothermia and fibrillatory arrest is the preferred approach for reoperative mitral valve surgery after coronary artery bypass grafting in the presence of patent LIMA-LAD grafts. These data suggest that this approach is associated with decreased incidence of LIMA-LAD graft injury, as well as reduced transfusion requirements.

Authors+Show Affiliations

Division of Cardiac Surgery, Brigham & Women's Hospital, Boston, Massachusetts 02115, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

11603597

Citation

Byrne, J G., et al. "The Preferred Approach for Mitral Valve Surgery After CABG: Right Thoracotomy, Hypothermia and Avoidance of LIMA-LAD Graft." The Journal of Heart Valve Disease, vol. 10, no. 5, 2001, pp. 584-90.
Byrne JG, Karavas AN, Adams DH, et al. The preferred approach for mitral valve surgery after CABG: right thoracotomy, hypothermia and avoidance of LIMA-LAD graft. J Heart Valve Dis. 2001;10(5):584-90.
Byrne, J. G., Karavas, A. N., Adams, D. H., Aklog, L., Aranki, S. F., Filsoufi, F., & Cohn, L. H. (2001). The preferred approach for mitral valve surgery after CABG: right thoracotomy, hypothermia and avoidance of LIMA-LAD graft. The Journal of Heart Valve Disease, 10(5), 584-90.
Byrne JG, et al. The Preferred Approach for Mitral Valve Surgery After CABG: Right Thoracotomy, Hypothermia and Avoidance of LIMA-LAD Graft. J Heart Valve Dis. 2001;10(5):584-90. PubMed PMID: 11603597.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The preferred approach for mitral valve surgery after CABG: right thoracotomy, hypothermia and avoidance of LIMA-LAD graft. AU - Byrne,J G, AU - Karavas,A N, AU - Adams,D H, AU - Aklog,L, AU - Aranki,S F, AU - Filsoufi,F, AU - Cohn,L H, PY - 2001/10/18/pubmed PY - 2002/2/1/medline PY - 2001/10/18/entrez SP - 584 EP - 90 JF - The Journal of heart valve disease JO - J Heart Valve Dis VL - 10 IS - 5 N2 - BACKGROUND AND AIM OF THE STUDY: An alternative to avoid redo sternotomy in patients with patent left internal mammary artery-left anterior descending coronary artery (LIMA-LAD) grafts undergoing mitral valve surgery is right thoracotomy with moderate-deep hypothermia (approximately 20 degrees C) and fibrillatory arrest without aortic cross-clamping. Few reports exist which directly compare re-sternotomy and right thoracotomy. METHODS: Between July 1992 and February 2000, 47 patients (39 males, eight females; median age 66 years; range: 41-83 years; 41 in NYHA class III or IV) with patent LIMA-LAD grafts underwent mitral valve surgery. Thirty-seven patients were approached through a right thoracotomy with moderate-deep hypothermia (median 20 degrees C) and fibrillatory arrest (right thoracotomy group), and 10 were approached through a re-sternotomy, with aortic cross-clamping and cardioplegic arrest. The median ejection fraction was 42% (range: 20-71%). Univariate analysis was used to determine predictors of outcome, as well as to evaluate differences in characteristics between groups. RESULTS: Operative mortality (OM) and perioperative myocardial infarction for the entire cohort was 11% and 10%, respectively, and there were no inter-group differences. No preoperative characteristics were associated with OM. Two LIMA-LAD graft injuries occurred in the re-sternotomy group compared with none in the right thoracotomy group (20% versus 0%, p = 0.04). Transfusion requirements were also greater in the redo sternotomy group (median 7 versus 2 packed red blood cell units, p = 0.04). CONCLUSION: Right thoracotomy with moderate-deep hypothermia and fibrillatory arrest is the preferred approach for reoperative mitral valve surgery after coronary artery bypass grafting in the presence of patent LIMA-LAD grafts. These data suggest that this approach is associated with decreased incidence of LIMA-LAD graft injury, as well as reduced transfusion requirements. SN - 0966-8519 UR - https://www.unboundmedicine.com/medline/citation/11603597/The_preferred_approach_for_mitral_valve_surgery_after_CABG:_right_thoracotomy_hypothermia_and_avoidance_of_LIMA_LAD_graft_ L2 - https://medlineplus.gov/coronaryarterybypasssurgery.html DB - PRIME DP - Unbound Medicine ER -