title: The role of the minimally invasive beating heart technique in reoperative valve surgery.
abstract: OBJECTIVE
  We reviewed our experience to assess potential advantages of minimally invasive surgery without aortic clamping over conventional median sternotomy and cardioplegic arrest during reoperative valve surgery.
  
  
  METHODS
  From August 2008 to August 2010, 22 reoperative valve procedures were performed through a minimally invasive approach without aortic cross-clamping [no-clamp group (NCG)]. Postoperative results were compared to a matched population in terms of sex, age, and type of surgery, and operated through median sternotomy with aortic cross-clamping and cardioplegic arrest [clamp group (CG)].
  
  
  RESULTS
  We performed 17 mitral valve replacements (MVRs), one mitral valve repair, one MVR associated to a tricuspid plasty (TVP), and three isolated TVP in both groups. Cardiopulmonary bypass (CPB) time was 166 and 163 minutes in NCG and CG, respectively. Intra-aortic balloon pump was necessary in two (NCG) and three (CG) patients. Two patients died in both groups from multiorgan failure. Biochemical analysis showed no significant differences in perioperative lactate or creatine kinase-MB values.
  
  
  CONCLUSIONS
  Redo valve surgery with an unclamped aorta is feasible, effective, and at least as safe as surgery using cardioplegic arrest. There was, however, no difference in biochemical or clinical outcomes from conventional surgery using aortic clamping and cardioplegic techniques.
authors.affiliation: Department of Cardiac Surgery, Niguarda Cà Granda Hospital, Milano, Italy. allucbot@tiscali.it
authors.forename: Luca
authors.initials: L
authors.lastname: Botta
authors.forename: Aldo
authors.initials: A
authors.lastname: Cannata
authors.forename: Pasquale
authors.initials: P
authors.lastname: Fratto
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bruschi
authors.forename: Salvatore
authors.initials: S
authors.lastname: Trunfio
authors.forename: Carla
authors.initials: C
authors.lastname: Maneggia
authors.forename: Luigi
authors.initials: L
authors.lastname: Martinelli
mesh_terms: D000368:Aged; D001011:Aorta / Q000601:surgery; D002315:Cardiopulmonary Bypass; D002405:Catheterization, Central Venous; D002406:Catheterization, Peripheral; D003250:Constriction; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006324:Heart Arrest, Induced; D006349:Heart Valve Diseases / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods* / Q000401:mortality; D008943:Mitral Valve / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D056346:Sternotomy; D013908:Thoracotomy; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000601:surgery*