Port-access surgery as elective approach for mitral valve operation in re-do procedures.
BACKGROUND
Re-do mitral valve procedures performed through median sternotomy carry substantial mortality and morbidity. To avoid complications of sternal re-entry and to provide adequate mitral valve exposure, antero-lateral thoracotomy has been suggested by some authors.


METHODS
From October 1997 to January 2007, 677 mitral valve operations have been performed in our centre using port-access video-assisted right mini-thoracotomy. Among these, 241 (35.6%) were performed on patients who had undergone one or more previous cardiac surgery procedures.


RESULTS
Mean cardio-pulmonary bypass time and endo-clamp time were 117+/-46 min and 71+/-31 min, respectively. Arterial cannulation was performed either on the ascending aorta, with the endo-direct cannula (112 patients, 46.5%), or peripherally with a femoral artery approach (129 patients, 53.5%). Conversion to median sternotomy was necessary in only two patients (0.8%) due to aortic dissection (one case) and left ventricle free wall rupture (one case). Median intensive care unit stay was 24h, median mechanical ventilation time was 12h; median hospital stay was 8 days. Bleeding requiring surgical revision occurred in 12 patients (4.9%). Hospital mortality was 4.9% (12/241 patients).


CONCLUSIONS
Port-access video-assisted right mini-thoracotomy allows good results in a difficult subset of patients; it allows minimal adhesion dissection, short ICU and hospital stay. In our practice, this technique has become the treatment of choice for mitral valve re-do surgery.
Ricci
Davide
D
Division of Cardiac Surgery, San Giovanni Battista Hospital "Molinette", University of Torino, 10126 Turin, Italy. dricci@molinette.piemonte.it
Pellegrini
Carlo
C
Aiello
Marco
M
Alloni
Alessia
A
Cattadori
Barbara
B
D'Armini
Andrea M
AM
Rinaldi
Mauro
M
Viganò
Mario
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000209:etiology; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D008943:Mitral Valve / Q000601:surgery*; D012086:Reoperation / Q000009:adverse effects / Q000379:methods; D013249:Sternum / Q000601:surgery; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000379:methods; D013908:Thoracotomy / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome