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Minimally invasive right lateral thoracotomy without aortic cross-clamping: an attractive alternative to repeat sternotomy for reoperative mitral valve surgery.
J Heart Valve Dis. 2010 Mar; 19(2):236-43.JH

Abstract

BACKGROUND AND AIM OF THE STUDY

The study aim was to determine the safety and benefits of minimally invasive mitral valve surgery without aortic cross-clamping for mitral valve surgery after previous cardiac surgery.

METHODS

Between January 2006 and August 2008, a total of 90 consecutive patients (38 females, 52 males; mean age 66 +/- 9 years) underwent minimally invasive mitral valve surgery after having undergone previous cardiac surgery. Of these patients, 80 (89%) underwent mitral valve replacement and 10 (11%) mitral valve repair utilizing a small (5 cm) right lateral thoracotomy along the 4th or 5th intercostal space under fibrillatory arrest (mean temperature 28 +/- 2 degrees C). The predicted mortality, calculated using the Society of Thoracic Surgeons (STS) algorithm, was compared to the observed mortality.

RESULTS

The mean ejection fraction was 45 +/- 13%, mean NYHA class 3 +/- 1, while 66 patients (73%) had previous coronary artery bypass grafting and 37 (41%) had previous valve surgery. Twenty-six patients (29%) underwent non-elective surgery. Cardiopulmonary bypass was instituted through axillary (n = 19), femoral (n = 70) or direct use aortic (n = 1) cannulation. Operative mortality was 2% (2/90), lower than the STS-predicted mortality of 7%. Three patients (3%) developed acute renal failure postoperatively, one patient (1%) required new-onset hemodialysis, and one (1%) developed postoperative stroke. No patients developed postoperative myocardial infarction. The mean postoperative packed red blood cell transfusion requirement at 48 h was 2 +/- 3 units.

CONCLUSION

Minimally invasive right thoracotomy without aortic cross-clamping is an excellent alternative to conventional redo-sternotomy for reoperative mitral valve surgery. The present study confirmed that this technique is safe and effective in reducing operative mortality in high-risk patients undergoing reoperative cardiac surgery.

Authors+Show Affiliations

Vanderbilt Heart and Vascular Institute, Nashville, Tennessee, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20369510

Citation

Umakanthan, Ramanan, et al. "Minimally Invasive Right Lateral Thoracotomy Without Aortic Cross-clamping: an Attractive Alternative to Repeat Sternotomy for Reoperative Mitral Valve Surgery." The Journal of Heart Valve Disease, vol. 19, no. 2, 2010, pp. 236-43.
Umakanthan R, Petracek MR, Leacche M, et al. Minimally invasive right lateral thoracotomy without aortic cross-clamping: an attractive alternative to repeat sternotomy for reoperative mitral valve surgery. J Heart Valve Dis. 2010;19(2):236-43.
Umakanthan, R., Petracek, M. R., Leacche, M., Solenkova, N. V., Eagle, S. S., Thompson, A., Ahmad, R. M., Greelish, J. P., Ball, S. K., Hoff, S. J., Absi, T. S., Balaguer, J. M., & Byrne, J. G. (2010). Minimally invasive right lateral thoracotomy without aortic cross-clamping: an attractive alternative to repeat sternotomy for reoperative mitral valve surgery. The Journal of Heart Valve Disease, 19(2), 236-43.
Umakanthan R, et al. Minimally Invasive Right Lateral Thoracotomy Without Aortic Cross-clamping: an Attractive Alternative to Repeat Sternotomy for Reoperative Mitral Valve Surgery. J Heart Valve Dis. 2010;19(2):236-43. PubMed PMID: 20369510.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Minimally invasive right lateral thoracotomy without aortic cross-clamping: an attractive alternative to repeat sternotomy for reoperative mitral valve surgery. AU - Umakanthan,Ramanan, AU - Petracek,Michael R, AU - Leacche,Marzia, AU - Solenkova,Nataliya V, AU - Eagle,Susan S, AU - Thompson,Annemarie, AU - Ahmad,Rashid M, AU - Greelish,James P, AU - Ball,Stephen K, AU - Hoff,Steven J, AU - Absi,Tarek S, AU - Balaguer,Jorge M, AU - Byrne,John G, PY - 2010/4/8/entrez PY - 2010/4/8/pubmed PY - 2010/5/12/medline SP - 236 EP - 43 JF - The Journal of heart valve disease JO - J Heart Valve Dis VL - 19 IS - 2 N2 - BACKGROUND AND AIM OF THE STUDY: The study aim was to determine the safety and benefits of minimally invasive mitral valve surgery without aortic cross-clamping for mitral valve surgery after previous cardiac surgery. METHODS: Between January 2006 and August 2008, a total of 90 consecutive patients (38 females, 52 males; mean age 66 +/- 9 years) underwent minimally invasive mitral valve surgery after having undergone previous cardiac surgery. Of these patients, 80 (89%) underwent mitral valve replacement and 10 (11%) mitral valve repair utilizing a small (5 cm) right lateral thoracotomy along the 4th or 5th intercostal space under fibrillatory arrest (mean temperature 28 +/- 2 degrees C). The predicted mortality, calculated using the Society of Thoracic Surgeons (STS) algorithm, was compared to the observed mortality. RESULTS: The mean ejection fraction was 45 +/- 13%, mean NYHA class 3 +/- 1, while 66 patients (73%) had previous coronary artery bypass grafting and 37 (41%) had previous valve surgery. Twenty-six patients (29%) underwent non-elective surgery. Cardiopulmonary bypass was instituted through axillary (n = 19), femoral (n = 70) or direct use aortic (n = 1) cannulation. Operative mortality was 2% (2/90), lower than the STS-predicted mortality of 7%. Three patients (3%) developed acute renal failure postoperatively, one patient (1%) required new-onset hemodialysis, and one (1%) developed postoperative stroke. No patients developed postoperative myocardial infarction. The mean postoperative packed red blood cell transfusion requirement at 48 h was 2 +/- 3 units. CONCLUSION: Minimally invasive right thoracotomy without aortic cross-clamping is an excellent alternative to conventional redo-sternotomy for reoperative mitral valve surgery. The present study confirmed that this technique is safe and effective in reducing operative mortality in high-risk patients undergoing reoperative cardiac surgery. SN - 0966-8519 UR - https://www.unboundmedicine.com/medline/citation/20369510/Minimally_invasive_right_lateral_thoracotomy_without_aortic_cross_clamping:_an_attractive_alternative_to_repeat_sternotomy_for_reoperative_mitral_valve_surgery_ DB - PRIME DP - Unbound Medicine ER -