title: Should a video-assisted mini-thoracotomy be the approach of choice for reoperative mitral valve surgery?
abstract: OBJECTIVE
  Reoperative cardiac surgery carries a greater morbidity and mortality than primary cardiac surgery. The study aim was to compare perioperative outcomes in patients undergoing mitral valve surgery who had already undergone a previous cardiac operation using either a minimally invasive video-assisted (MIVA) mini-thoracotomy or a redo median sternotomy (MS).
  
  
  METHODS
  Between January 1996 and June 2003, 71 consecutive patients with prior cardiac surgery underwent mitral valve surgery. Of these operations, 38 were MIVA procedures, performed through a 5-cm right anterior thoracotomy using voice-activated robotic camera control (AESOP 3000). Outcome was compared with results in 33 consecutive patients who underwent a standard redo MS.
  
  
  RESULTS
  The MIVA and redo MS cohorts differed in preoperative ejection fraction (46 +/- 2% versus 55 +/- 2%; p = 0.004) and percentage of urgent operations (33 versus 8.3%; p = 0.01). Operative mortality was similar in both groups (5.7% and 5.9% respectively; p = 0.976), as were cardiopulmonary bypass, operating room, and ICU times. Postoperative intubation time was shorter in the MIVA group than in the redo MS group (29.1 +/- 8.9 versus 38.0 +/- 9.9 h; p = 0.008), and blood transfusion requirements were also reduced (2.9 +/- 0.6 versus 5.5 +/- 0.7 units; p = 0.001) respectively. Length of hospital stay was significantly less in the MIVA group (7.1 +/- 1.3 versus 11.2 +/- 1.1 days; p = 0.001).
  
  
  CONCLUSIONS
  Minimally invasive video-assisted mitral valve operations may be performed safely and efficiently in patients with prior cardiac surgery. Demonstrated advantages include fewer red blood cell and blood product transfusions, as well as decreased intubation time and length of hospital stay.
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, Brody School of Medicine, East Carolina University, Greenville, NC, USA. Bolotin@tasmc.health.gov.il
authors.forename: Gil
authors.initials: G
authors.lastname: Bolotin
authors.forename: Alan P
authors.initials: AP
authors.lastname: Kypson
authors.forename: Clifton C
authors.initials: CC
authors.lastname: Reade
authors.forename: Victor F
authors.initials: VF
authors.lastname: Chu
authors.forename: William L
authors.initials: WL
authors.lastname: Freund
authors.forename: L Wiley
authors.initials: LW
authors.lastname: Nifong
authors.forename: W Randolph
authors.initials: WR
authors.lastname: Chitwood
mesh_terms: D000368:Aged; D006349:Heart Valve Diseases / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D008943:Mitral Valve / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D012086:Reoperation; D013318:Stroke Volume / Q000502:physiology; D016019:Survival Analysis; D020775:Thoracic Surgery, Video-Assisted; D013908:Thoracotomy; D016896:Treatment Outcome