title: Left thoracotomy for multiple-time redo mitral valve surgery using on-pump beating heart technique.
abstract: BACKGROUND
  There are limited reports describing multiple-time redo mitral valve surgery using a left thoracotomy approach and on-pump beating heart technique.
  
  
  METHODS
  A retrospective review of medical records for 16 patients from March 2002 to June 2007 was performed.
  
  
  RESULTS
  Mean age was 54 +/- 17 (mean +/- SD) years (8 males). Preoperative mitral valve regurgitation was 3.6 +/- 0.6 in 14, and 2 had severe mitral valve stenosis. New York Heart Association symptom class was 2.9 +/- 1.0 and ejection fraction was 0.4 +/- 0.15 (range, 0.2 to 0.6). Previous cardiac operations were performed twice in 14 and three times in 2 patients with an interval of 4.8 +/- 5.5 years since the last. The procedures included repair (5), replacement (8), and re-replacement (3). All were performed through a fifth intercostal space, left posterolateral thoracotomy with the heart beating on cardiopulmonary bypass (32 to 37 degrees C). Left femoral artery or descending thoracic aorta inflow and left femoral vein or left main pulmonary artery venous drainage with vacuum assist were used. Operation time was 221 +/- 51 minutes and cardiopulmonary bypass time was 71 +/- 27 minutes. Postoperative ventilation time was 10.0 +/- 7.7 hours, intensive care unit stay was 2.9 +/- 1.9 days, and hospital stay was 6.2 +/- 2.4 days. There were two 30-day mortalities and two died late with a follow-up of 30 +/- 22 months.
  
  
  CONCLUSIONS
  Left thoracotomy using the on-pump beating heart technique is safe, effective, and should be considered for multiple-time redo mitral valve surgery.
authors.affiliation: Department of Surgery, Section of Cardiac Surgery, Cardiovascular Center, University of Michigan Health System, Ann Arbor, Michigan 48109-5864, USA.
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Suzuki
authors.forename: Francis D
authors.initials: FD
authors.lastname: Pagani
authors.forename: Steven F
authors.initials: SF
authors.lastname: Bolling
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002315:Cardiopulmonary Bypass; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve; D012086:Reoperation; D013908:Thoracotomy