title: Minimally invasive approach for redo mitral valve surgery: a true benefit for the patient.
abstract: OBJECTIVE
  Redo mitral valve surgery via sternotomy is associated with a substantial morbidity and mortality. This study evaluated a minimally invasive technique for mitral valve redo procedures.
  
  
  METHODS
  Out of a series of 394 patients undergoing mitral valve repair or replacement via a right minithoracotomy, 39 patients underwent redo mitral valve surgery (59+/-13 years, 23 female). Previous cardiac surgeries included 17 patients with mitral valve repair, 6 patients with mitral valve replacement, 3 patients with aortic valve replacement, 2 patients with atrial septal defect closure, and 11 patients with coronary artery bypass grafting (CABG). In all cases, femoro-femoral cannulation was performed. The port access technique was applied in patients undergoing redo valve surgery. In patients with prior CABG, the operation was performed using deep hypothermia and ventricular fibrillation.
  
  
  RESULTS
  In all cases, sternotomy was avoided. The mitral valve was replaced in 20 patients and repaired in 19. Time of surgery and cross-clamp time were comparable with the overall series (168+/-73 [redo] vs 168+/-58 min and 52+/-21 [redo] vs 58+/-25 min). Mortality was 5.1%. One patient had transient hemiplegia due to the migration of the endoclamp. All other patients had uneventful outcomes and normal mitral valve function at 3-month's follow-up.
  
  
  CONCLUSIONS
  Redo mitral valve surgery can be performed safely using a minimally invasive approach in patients with a previous sternotomy. The right lateral minithoracotomy offers excellent exposure. It minimizes the need for cardiac dissection, and thus, the risk for injury. Avoiding a resternotomy increases patient comfort of redo mitral valve surgery.
authors.affiliation: Department of Cardiac Surgery, Heartcenter, University of Leipzig, Germany.
authors.forename: J F
authors.initials: JF
authors.lastname: Onnasch
authors.forename: F
authors.initials: F
authors.lastname: Schneider
authors.forename: V
authors.initials: V
authors.lastname: Falk
authors.forename: T
authors.initials: T
authors.lastname: Walther
authors.forename: J
authors.initials: J
authors.lastname: Gummert
authors.forename: F W
authors.initials: FW
authors.lastname: Mohr
mesh_terms: D000328:Adult; D000368:Aged; D002315:Cardiopulmonary Bypass / Q000295:instrumentation; D015150:Echocardiography, Doppler; D017548:Echocardiography, Transesophageal; D005260:Female; D005858:Germany / Q000453:epidemiology; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D010496:Pericardium / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology; D011788:Quality of Life; D012086:Reoperation; D013525:Surgical Instruments; D013997:Time Factors; D016896:Treatment Outcome