title: Mitral valve reoperation under ventricular fibrillation through right mini-thoracotomy using three-dimensional videoscope.
abstract: BACKGROUND
  Conventional reoperative mitral valve surgery by median sternotomy has several difficulties. We performed mitral valve replacement (MVR) under ventricular fibrillation (VF) through right mini-thoracotomy with three-dimensional videoscope for avoiding the problems.
  
  
  METHODS
  Between 2006 and 2011, we performed 257 cases of MVR, in which 125 cases underwent isolated MVR. Ten cases of patients underwent reoperative MVR under VF through thoracotomy with three-dimensional videoscope (Group I), and 27 cases of patients underwent reoperative conventional MVR through median sternotomy (Group II). We retrospectively reviewed the outcomes and compared Group I with Group II. Preoperative left ventricular ejection fraction (LVEF) was significantly lower (50.5 ± 19.8% vs 64.4 ± 12.0%; p = 0.046), and significantly higher Euro SCORE was found in Group I (4.8 ± 2.0 vs 3.8 ± 2.4; p = 0.037).
  
  
  RESULTS
  Although Group I required cooling and rewarming time, average operative times was significantly shorter in Group I (262 ± 46 min vs 300 ± 57 min; p = 0.044), and cardiopulmonary bypass times and average VF times in Group I and aortic cross-clamp times in Group II were equivalent. There was no significant difference in the average of postoperative maximum creatine kinase (CK)-MB. In-hospital mortality was 0/10 (0%) and 1/27 (3.7%), and postoperative paravalvular leakage occurred in 0/10 (0%) and 1/27 (3.7%), and stroke occurred in 1/10 (10%) and 1/27 (3.7%) for Groups I and II. Two patients underwent reoperation for bleeding in Group II. Intensive care unit stay in Group I was significantly shorter than in Group II (1.8 ± 0.6 days vs 3.0 ± 1.7 days; p = 0.025).
  
  
  CONCLUSIONS
  The higher risk of preoperative background in Group I had no effect on the operation. Mitral valve surgery under VF through right mini-thoracotomy can be an alternative procedure for reoperation after conventional various cardiothoracic surgeries.
authors.affiliation: Department of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama, 2-5-1 Nakaicho, Okayama, Kita-ku 700-0804, Japan. bassbord1028@yahoo.co.jp
authors.forename: Arudo
authors.initials: A
authors.lastname: Hiraoka
authors.forename: Masahiko
authors.initials: M
authors.lastname: Kuinose
authors.forename: Toshinori
authors.initials: T
authors.lastname: Totsugawa
authors.forename: Genta
authors.initials: G
authors.lastname: Chikazawa
authors.forename: Hidenori
authors.initials: H
authors.lastname: Yoshitaka
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D059035:Perioperative Period; D012086:Reoperation / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D056346:Sternotomy; D013908:Thoracotomy / Q000009:adverse effects / Q000379:methods*; D014693:Ventricular Fibrillation; D020535:Video-Assisted Surgery / Q000009:adverse effects / Q000379:methods*