Minimally invasive redo mitral valve surgery without aortic crossclamp

Rodrigo Milani,Luis Fernando Binder,Victor Hugo Lima,Aline Sanches,Matheus Rosa,Luiz Patrial Neto,Paulo Roberto Slud Brofman,Sergio Oliveira

doi:10.5935/1678-9741.20130051

Rodrigo Milani, Luis Fernando Binder + Show 6 more

Open Access

https://doi.org/10.5935/1678-9741.20130051

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Abstract

Reoperations of the mitral valve have a higher rate of complications when compared with the first surgery. With the field of video-assisted techniques for the first surgery of mitral valve became routine, reoperation cases began to arouse interest for this less invasive procedures. To assess the results and the technical difficulties in 10 patients undergoing minimally invasive redo mitral valve surgery. Cardiopulmonary bypass was installed through a cannula placed in the femoral vessels and right internal jugular vein, conducted in 28 degrees of temperature in ventricular fibrillation. A right lateral thoracotomy with 5 to 6 cm in the third or fourth intercostal space was done, pericardium was displaced only at the point of atriotomy. The aorta was not clamped. Ten patients with mean age of 56.9 ± 10.5 years, four were in atrial fibrilation rhythm and six in sinusal. Average time between first operation and reoperations was 11 ± 3.43 years. The mean EuroSCORE group was 8.3 ± 1.82. The mean ventricular fibrillation and cardiopulmonary bypass was respectively 70.9 ± 17.66 min and 109.4 ± 25.37 min. The average length of stay was 7.6 ± 1.5 days. There were no deaths in this series. Mitral valve reoperation can be performed through less invasive techniques with good immediate results, low morbidity and mortality. However, this type of surgery requires a longer duration of cardiopulmonary bypass, especially in cases where the patient already has prosthesis. The presence of a minimal aortic insufficiency also makes this procedure technically more challenging.

Highlights

Reoperations of the mitral valve have a higher rate of complications when compared with the first surgery
Myocardial protection can be achieved through the use of endovascular clamp, aortic clamping with the placement of the clamp via parallel access, or through surgeries performed without aortic clamping and with the patient under hypothermia with ventricular fibrillation
The goal of this study is to describe the immediate results of tem patients who underwent video-assisted minimally invasive mitral valve reoperation, under hypothermic ventricular fibrillation and without aortic clamping

Summary

Introduction

Reoperations of the mitral valve have a higher rate of complications when compared with the first surgery. Conclusion: Mitral valve reoperation can be performed through less invasive techniques with good immediate results, low morbidity and mortality. Alternatives to sternotomy have been put forward in order to reduce morbidity and mortality, provide faster recovery, and offer better aesthetic results These alternatives include: partial sternotomy, mini right anterolateral thoracotomy performed under direct vision or video-assisted as well as robotic mitral valve surgery. These procedures can be performed either using longer common instruments coupled with small retractors or with the help of complex, expensive instruments. Using an alternative access to the sternotomy results in the preservation of chest wall integrity, which in turn leads to improved lung function, less pain, shorter hospital stay, and faster return to normal routine

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