Approach to the mitral valve through a right thoracotomy in potentially hazardous reoperation.

Abstract

Repeat sternotomy for mitral valve surgery may be hazardous in some patients. A right thoracotomy avoids the densely scarred area beneath the sternum and provides adequate in-line exposure of the mitral valve. Between 1994 and 1997, five patients were reoperated for a mitral valve or prosthesis dysfunction through a right thoracotomy. Indications were three second redo-mitral valve surgeries and two first redo, once in a patient with an aortic prosthesis and once in a patient with patent aortocoronary grafts. The operation was performed without clamping the ascending aorta in moderate hypothermic (four patients) or normothermia (one patient). Exposure of the mitral valve for replacement (four patients) or for repair of a paraprosthetic leak (one patient) was optimal in all patients. Resumption of cardiac function occurred rapidly after repair without specific support. Postoperative course was uncomplicated. Blood loss ranged from 300 to 700 mL. Patients were discharged from 7 to 12 days postoperatively. They are in New York Heart Association (NYHA) functional Class I (four patients) and II (one patient), from 3 to 42 months postoperatively. Right thoracotomy provides a direct "in the line of vision" access to the mitral valve. Because complete de-airing of the heart is difficult and respiratory function depressed after a right thoracotomy, this approach seems suitable when technical difficulties are expected in sternal reopening.