title: Outcomes of right minithoracotomy mitral valve surgery in patients with previous sternotomy.
abstract: BACKGROUND
  We evaluated the outcomes of patients with a history of previous sternotomy who underwent minimally invasive mitral valve surgery through a right minithoracotomy approach.
  
  
  METHODS
  We reviewed all the isolated mitral valve operations performed at our institution between January 1, 2005, and October 8, 2010, and selected for analysis only patients who had had a prior sternotomy. The outcome of patients who underwent a minimally invasive approach was compared with that of patients whose mitral surgery was performed through a standard median sternotomy.
  
  
  RESULTS
  There were 88 patients with prior sternotomy, with 59 having minimally invasive surgery and 29 undergoing a repeat median sternotomy. Significant baseline differences (minimally invasive versus sternotomy, respectively) included the number of male patients (76% versus 45%, p=0.003), prior coronary artery bypass graft surgery (71% versus 45%, p=0.02), prior valve surgery (47% versus 72%, p=0.03), congestive heart failure (46% versus 76%, p=0.008), and diabetes mellitus (34% versus 10%, p=0.02). The in-hospital mortality and composite postoperative complications were 3% versus 14% (p=0.07) and 29% versus 66% (p=0.001) for the minimally invasive versus the median sternotomy group, respectively. The intensive care unit stay and hospital length of stay were 48 hours (interquartile range [IQR], 41 to 90) versus 118 hours (IQR, 67 to 167; p<0.001), and 8 days (IQR, 6 to 12) versus 13 days (IQR, 9 to 18; p=0.001), for the minimally invasive and median sternotomy groups, respectively.
  
  
  CONCLUSIONS
  Minimally invasive mitral valve surgery in patients who have had a prior sternotomy is associated with improved postoperative outcomes and reduced resource utilization, when compared with a median sternotomy approach.
authors.affiliation: Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, Florida 33140, USA.
authors.forename: Christos G
authors.initials: CG
authors.lastname: Mihos
authors.forename: Orlando
authors.initials: O
authors.lastname: Santana
authors.forename: Gervasio A
authors.initials: GA
authors.lastname: Lamas
authors.forename: Joseph
authors.initials: J
authors.lastname: Lamelas
mesh_terms: D000368:Aged; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D008943:Mitral Valve / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D056346:Sternotomy; D013908:Thoracotomy / Q000009:adverse effects / Q000401:mortality; D016896:Treatment Outcome