EP10 DIRECT AORTIC CROSS-CLAMPING IN REDO MITRAL VALVE SURGERY VIA RIGHT MINI-THORACOTOMY

Abstract

Abstract Background And Aim: Reoperative mitral valve surgery is burdened by a greater technical difficulty and a higher complications rate respect to first operation. When in a heart centre minimally invasive surgery has become routine, the application of this to reoperations may represent the way to greatly reduce the surgical risk. The objective of the study is to assess results within the last year of technically difficult reoperations in 10pts with mitral valve disease approached trough a 5–7 cm right mini-thoracotomy with direct cross clamping. Methods: Cardiopulmonary bypass was installed by cannulation of femoral vein (internal jugular vein in case of tricuspid concomitant surgery) and axillary or femoral artery. Aorta was partially isolated and directly cross-clamped by the same incision. Results: Patients enrolled had a median age 68 years (IQR I-III 61–75). Median time between last operation and reoperation was 7 years (IQR I-III 4–11): 1 patient underwent mitral valve repair, 9 patients to mitral valve replacement and 3 of these also received tricuspid annuloplasty. Median Euroscore I was 8.5 (IQR I-III 6.1–12). Median cross-clamp time was 68 min (IQR I-III 51–86) and median cardiopulmonary bypass time was 88 min (IQR I-III 68.8–119). 1 patient had a postoperative renal failure requiring CVVH and 1 patient underwent surgical reoperation for bleeding. There were no deaths at 30day follow-up. Conclusions: Direct aortic cross-clamping in minimally invasive mitral valve surgery reoperations is a safe procedure. The use of less invasive techniques in reoperations may minimize morbidity and mortality, without prolonging duration of cardiopulmonary bypass.