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Should a video-assisted mini-thoracotomy be the approach of choice for reoperative mitral valve surgery?
J Heart Valve Dis. 2004 Mar; 13(2):155-8; discussion 158.JH

Abstract

BACKGROUND AND AIM OF THE STUDY

Reoperative cardiac surgery carries a greater morbidity and mortality than primary cardiac surgery. The study aim was to compare perioperative outcomes in patients undergoing mitral valve surgery who had already undergone a previous cardiac operation using either a minimally invasive video-assisted (MIVA) mini-thoracotomy or a redo median sternotomy (MS).

METHODS

Between January 1996 and June 2003, 71 consecutive patients with prior cardiac surgery underwent mitral valve surgery. Of these operations, 38 were MIVA procedures, performed through a 5-cm right anterior thoracotomy using voice-activated robotic camera control (AESOP 3000). Outcome was compared with results in 33 consecutive patients who underwent a standard redo MS.

RESULTS

The MIVA and redo MS cohorts differed in preoperative ejection fraction (46 +/- 2% versus 55 +/- 2%; p = 0.004) and percentage of urgent operations (33 versus 8.3%; p = 0.01). Operative mortality was similar in both groups (5.7% and 5.9% respectively; p = 0.976), as were cardiopulmonary bypass, operating room, and ICU times. Postoperative intubation time was shorter in the MIVA group than in the redo MS group (29.1 +/- 8.9 versus 38.0 +/- 9.9 h; p = 0.008), and blood transfusion requirements were also reduced (2.9 +/- 0.6 versus 5.5 +/- 0.7 units; p = 0.001) respectively. Length of hospital stay was significantly less in the MIVA group (7.1 +/- 1.3 versus 11.2 +/- 1.1 days; p = 0.001).

CONCLUSION

Minimally invasive video-assisted mitral valve operations may be performed safely and efficiently in patients with prior cardiac surgery. Demonstrated advantages include fewer red blood cell and blood product transfusions, as well as decreased intubation time and length of hospital stay.

Authors+Show Affiliations

Department of Surgery, Division of Cardiothoracic Surgery, Brody School of Medicine, East Carolina University, Greenville, NC, USA. Bolotin@tasmc.health.gov.ilNo 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

15086251

Citation

Bolotin, Gil, et al. "Should a Video-assisted Mini-thoracotomy Be the Approach of Choice for Reoperative Mitral Valve Surgery?" The Journal of Heart Valve Disease, vol. 13, no. 2, 2004, pp. 155-8; discussion 158.
Bolotin G, Kypson AP, Reade CC, et al. Should a video-assisted mini-thoracotomy be the approach of choice for reoperative mitral valve surgery? J Heart Valve Dis. 2004;13(2):155-8; discussion 158.
Bolotin, G., Kypson, A. P., Reade, C. C., Chu, V. F., Freund, W. L., Nifong, L. W., & Chitwood, W. R. (2004). Should a video-assisted mini-thoracotomy be the approach of choice for reoperative mitral valve surgery? The Journal of Heart Valve Disease, 13(2), 155-8; discussion 158.
Bolotin G, et al. Should a Video-assisted Mini-thoracotomy Be the Approach of Choice for Reoperative Mitral Valve Surgery. J Heart Valve Dis. 2004;13(2):155-8; discussion 158. PubMed PMID: 15086251.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Should a video-assisted mini-thoracotomy be the approach of choice for reoperative mitral valve surgery? AU - Bolotin,Gil, AU - Kypson,Alan P, AU - Reade,Clifton C, AU - Chu,Victor F, AU - Freund,William L,Jr AU - Nifong,L Wiley, AU - Chitwood,W Randolph,Jr PY - 2004/4/17/pubmed PY - 2004/11/9/medline PY - 2004/4/17/entrez SP - 155-8; discussion 158 JF - The Journal of heart valve disease JO - J Heart Valve Dis VL - 13 IS - 2 N2 - BACKGROUND AND AIM OF THE STUDY: Reoperative cardiac surgery carries a greater morbidity and mortality than primary cardiac surgery. The study aim was to compare perioperative outcomes in patients undergoing mitral valve surgery who had already undergone a previous cardiac operation using either a minimally invasive video-assisted (MIVA) mini-thoracotomy or a redo median sternotomy (MS). METHODS: Between January 1996 and June 2003, 71 consecutive patients with prior cardiac surgery underwent mitral valve surgery. Of these operations, 38 were MIVA procedures, performed through a 5-cm right anterior thoracotomy using voice-activated robotic camera control (AESOP 3000). Outcome was compared with results in 33 consecutive patients who underwent a standard redo MS. RESULTS: The MIVA and redo MS cohorts differed in preoperative ejection fraction (46 +/- 2% versus 55 +/- 2%; p = 0.004) and percentage of urgent operations (33 versus 8.3%; p = 0.01). Operative mortality was similar in both groups (5.7% and 5.9% respectively; p = 0.976), as were cardiopulmonary bypass, operating room, and ICU times. Postoperative intubation time was shorter in the MIVA group than in the redo MS group (29.1 +/- 8.9 versus 38.0 +/- 9.9 h; p = 0.008), and blood transfusion requirements were also reduced (2.9 +/- 0.6 versus 5.5 +/- 0.7 units; p = 0.001) respectively. Length of hospital stay was significantly less in the MIVA group (7.1 +/- 1.3 versus 11.2 +/- 1.1 days; p = 0.001). CONCLUSION: Minimally invasive video-assisted mitral valve operations may be performed safely and efficiently in patients with prior cardiac surgery. Demonstrated advantages include fewer red blood cell and blood product transfusions, as well as decreased intubation time and length of hospital stay. SN - 0966-8519 UR - https://www.unboundmedicine.com/medline/citation/15086251/Should_a_video_assisted_mini_thoracotomy_be_the_approach_of_choice_for_reoperative_mitral_valve_surgery L2 - https://medlineplus.gov/heartvalvediseases.html DB - PRIME DP - Unbound Medicine ER -