title: Redo mitral valve surgery using the port-access system.
abstract: Redo mitral valve surgery is hazardous, hence we explored an alternative approach using a port-access system that avoids reentry. Between October 1997 and December 2000, 32 patients underwent mitral reoperation using the system. All patients had previous cardiac operations. This procedure consisted of a right anterolateral minithoracotomy and femorofemoral cannulation using special port-access instruments and endoaortic clamping in 24 patients or direct transthoracic sliding-rod aortic clamping in 8. The valve disease was of rheumatic etiology in 28 patients and degenerative in 4. The valve was replaced in 31 cases and a paravalvular leak after mitral valve replacement was closed in 1. In 2 cases, the tricuspid valve was repaired along with mitral valve replacement. Mean total operating time was 4.5 +/- 1.2 hours, cardiopulmonary bypass time 162 +/- 72 minutes, and aortic crossclamp time 62 +/- 21 minutes. There was no mortality, and mean stay in the intensive care unit was 22 +/- 7 hours and hospital stay 6.4 +/- 1.2 days. Postoperative blood transfusion was required in 12 patients. In view of the favorable results, we recommend using the port-access system as a standard approach for mitral reoperation.
authors.affiliation: Department of Cardiovascular Surgery Escorts Heart Institute and Research Centre New Delhi, India.
authors.forename: Naresh
authors.initials: N
authors.lastname: Trehan
authors.forename: Yugal K
authors.initials: YK
authors.lastname: Mishra
authors.forename: Satish G
authors.initials: SG
authors.lastname: Mathew
authors.forename: Krishna K
authors.initials: KK
authors.lastname: Sharma
authors.forename: Sameer
authors.initials: S
authors.lastname: Shrivastava
authors.forename: Yatin
authors.initials: Y
authors.lastname: Mehta
mesh_terms: D000328:Adult; D002408:Catheters, Indwelling / Q000009:adverse effects*; D005240:Feasibility Studies; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D011168:Portal System / Q000601:surgery*; D011183:Postoperative Complications; D012086:Reoperation / Q000009:adverse effects* / Q000379:methods*