Author + information
- Rama K. Krishna,
- Nisharahmed Kherada,
- Chrish Mihos and
- Orlando Santana
Minimally invasive valve surgery is less traumatic than the standard median sternotomy. Multiple redo (more than two) cardiac surgeries have become more frequent as the population ages. These cases may have a prohibitive re-operative mortality and morbidity with standard sternotomy. A less invasive right thoracotomy approach is emerging as an alternative to the standard redo median sternotomy.
We retrospectively reviewed the medical records between January 2009 and December 2014 and identified 38 patients with history of two or more cardiac surgeries, who underwent repeat valve surgery via a right thoracotomy approach.
The mean age was 65.8 ± 14.6 years, and 23 (61%) patients were male. There were 9 (24%) patients had two prior coronary artery bypass graft surgeries, 18 (47%) had more than two prior valve replacement surgeries, and 10 (26%) had more than two combined CABG and valve surgeries. The median Society of Thoracic Surgeons score for mortality was predicted to be 5.2% (IQR, 2.48-8.03%). Eight (21%) patients underwent minimally invasive isolated aortic valve replacement, 27 (71%) had mitral valve repair/replacement, 5 (13%) had tricuspid valve repair, and 3 patients needed double valve surgery. Baseline characteristics and postoperative outcomes are summarized in Table 1. The median postoperative length of stay was 9.5 days (IQR, 7-16) and intensive care unit length of stay was 46.5 hours (IQR, 39.4-88.5). Thirty-day mortality was 3 (8%) and composite post-operative morbidity and mortality occurred in 15 (39.5%) patients. Follow up was available in 38 patients (100%) and has extended up to five years. Long term survival at one and three years was 91% and 83% respectively.
Minimally invasive valve surgery after multiple redo cardiac surgery is feasible and associated with a low morbidity and mortality.
|Age (years, mean ± SD)||65.8±14.6|
|Male gender||23 (61%)|
|Body mass index (Kg/m2, mean ± SD)||25.8 ± 4.8|
|Preoperative creatinine (mg/dL, mean ± SD)||1.30 ± 0.64|
|Left ventricular ejection fraction (%, mean ± SD)||44.2 ± 13.8|
|Diabetes mellitus||11 (29%)|
|Peripheral vascular disease||7 (18%)|
|Cerebrovascular disease||9 (24%)|
|Previous coronary artery bypass graft surgery||20 (53%)|
|Previous valve surgery||28 (74%)|
|Re-operation for bleeding||4 (10%)|
|Acute kidney injury||3 (9%)|
|Atrial fibrillation||7 (18%)|
|Cerebrovascular accident||2 (5%)|
|Deep wound infection||0|
|Prolonged ventilation||6 (15%)|
|Thirty day mortality||3 (8%)|