title: Minimally invasive mitral valve surgery after previous sternotomy: experience in 181 patients.
abstract: OBJECTIVE
  This study evaluated the results for minimally invasive mitral valve (MV) surgery in patients who had undergone previous cardiac operations through a sternotomy.
  
  
  METHODS
  From March 1, 1999 to January 2008, minimally invasive MV reoperations were performed in 181 consecutive patients (110 men) with a mean age of 64.5 +/- 12 years. A right-sided lateral minithoracotomy with femoral cannulation for cardiopulmonary bypass (CPB) was used. The principal indication was symptomatic severe mitral regurgitation (mean grade, 3.0 +/- 0.8). Previous procedures were isolated coronary bypass grafting (CABG) in 76 (42%), isolated valve operation, 55 (30%); combined CABG and valve, 16 (9%); and other cardiac operations, 34 (19%). MV replacement was previously performed in 19 patients and MV repair in 31. Mean preoperative left ventricular ejection fraction was 0.54 +/- 0.16.
  
  
  RESULTS
  MV repair, including repeat repair, was performed in 109 patients (60%) and MV replacement in 72 (40%). Operations were performed during ventricular fibrillation in 140 (77%), and a transthoracic aortic cross-clamp was used in 31 (17%). Ten patients (6%) underwent beating heart operations with CPB support. Mean total operating time was 176 +/- 50 min. Mean CPB time was 135 +/- 40 min. Thirty-day mortality was 6.6%. Early echocardiographic follow-up revealed excellent valve function in most patients.
  
  
  CONCLUSIONS
  A minimally invasive approach is a useful alternative for patients requiring a MV procedure after a previous cardiac operation, particularly in patients with patent coronary bypass grafts or previous aortic valve replacement. Very good perioperative results can be achieved with this method.
authors.affiliation: Heart Center, Leipzig University, Leipzig, Germany. j.seeburger@web.de
authors.forename: Joerg
authors.initials: J
authors.lastname: Seeburger
authors.forename: Michael A
authors.initials: MA
authors.lastname: Borger
authors.forename: Volkmar
authors.initials: V
authors.lastname: Falk
authors.forename: Jurgen
authors.initials: J
authors.lastname: Passage
authors.forename: Thomas
authors.initials: T
authors.lastname: Walther
authors.forename: Nicolas
authors.initials: N
authors.lastname: Doll
authors.forename: Friedrich W
authors.initials: FW
authors.lastname: Mohr
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D008943:Mitral Valve / Q000601:surgery*; D012086:Reoperation; D013249:Sternum / Q000601:surgery