Abstract

OBJECTIVES

A minimally invasive approach via a thoracotomy is an alternative in challenging redo cardiac procedures. Our goal was to present our early postoperative experience with minimally invasive cardiac surgery via a right minithoracotomy (minimally invasive) and resternotomy in patients undergoing a mitral valve procedure as a reoperation.

METHODS

From 2017 until 2020, reoperation of the mitral valve was performed through a right-sided minithoracotomy in 27 patients and via a resternotomy in 26 patients. Patients with femoral vessels suitable for cannulation underwent a minimally invasive technique. Patients requiring concomitant procedures regarding the aortic valve were operated on via a resternotomy.

RESULTS

The mean age was 66 ± 12 years in the minimally invasive group and 65 ± 12 years in the whole cohort. The average Society of Thoracic Surgeons score was 11 ± 10% in the minimally invasive group and 13 ± 9% in all patients. The majority of the patients underwent reoperation because of severe mitral valve insufficiency (48% and 55%, respectively). The mean time to reoperation was 7 ± 9 years (minimally invasive group). The 30-day mortality was 4% in the minimally invasive group and 11% in the whole cohort. The blood loss was 566 ± 359 ml in the minimally invasive group and 793 ± 410 ml totally. There were no postoperative neurological complications in the minimally invasive group and 1 (2%) in the whole cohort. Postoperative echocardiography revealed competent mitral valve/prosthesis function in all patients.

CONCLUSIONS

A minimally invasive approach for a mitral valve reoperation in selected patients is a safe alternative to resternotomy with a low transfusion requirement. Both surgical techniques are associated with good postoperative outcomes.

中文翻译：

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重做二尖瓣手术患者的右侧小切口和胸骨再切开术

摘要

目标

通过开胸手术的微创方法是具有挑战性的重做心脏手术的替代方法。我们的目标是展示我们通过右侧小切口（微创）和再切开二尖瓣手术作为再次手术的患者进行微创心脏手术的早期术后经验。

方法

从 2017 年到 2020 年，27 名患者通过右侧小切口进行二尖瓣再手术，26 名患者通过再切开术进行二尖瓣再手术。适合插管的股血管患者接受了微创技术。需要伴随主动脉瓣手术的患者通过再切开术进行手术。

结果

微创组的平均年龄为 66 ± 12 岁，整个队列的平均年龄为 65 ± 12 岁。胸外科医师协会的平均评分在微创组为 11 ± 10%，在所有患者中为 13 ± 9%。大多数患者因严重的二尖瓣关闭不全而接受了再次手术（分别为 48% 和 55%）。再次手术的平均时间为 7 ± 9 年（微创组）。微创组的 30 天死亡率为 4%，整个队列为 11%。微创组失血量为566±359 ml，总失血量为793±410 ml。微创组没有术后神经系统并发症，整个队列有 1 例（2%）。术后超声心动图显示所有患者的二尖瓣/假体功能正常。

结论

对选定患者进行二尖瓣再手术的微创方法是一种安全的替代再切开术且输血需求低的方法。这两种手术技术都与良好的术后结果相关。