title: Mitral valve surgery using video-assisted right minithoracotomy and deep hypothermic perfusion in patients with previous cardiac operations.
abstract: BACKGROUND
  Redo-sternotomy for mitral valve (MV) surgery may be complex and attendant complications can be avoided using anterolateral right thoracotomy, deep hypothermia (20°C, nasopharyngeal) with low flow cardiopulmonary perfusion. Video-assisted minithoracotomy technique is a further improvement.
  
  
  METHODS
  We performed 20 consecutive MV operations in patients with previous cardiac surgery using video-assisted right minithoracotomy, femoro-femoral bypass, deep hypothermia, low flow cardiopulmonary bypass without aortic cross-clamping. The mean follow-up was 30 ± 17.8 mo. Data is presented as the mean ± standard deviation of the mean.
  
  
  RESULTS
  There were 11 males and 9 females (age, 62.3 ± 12.1; ejection fraction 50.1 ± 11.2). Operations included MV replacement (n = 11), MV repair (n = 5), and MV re-replacement (n = 4). There were no hospital deaths, and the mean hospital stay was 8 ± 2.9 days. There were no postoperative strokes or need for mechanical circulatory support. The mean cardiopulmonary bypass time was 152 ± 28 minutes. Two patients (10%) required inotropic support beyond 24 hrs. All patients were free from inotropic support at 48 hours. The mean number of transfused red cell units was 2.8 ± 0.8 (range, 2 to 4). One patient died in another institution six months postoperatively following surgery for acute type III aortic dissection. At 30 ± 17.8 months follow-up all patients were found to be in NYHA Class I or II.
  
  
  CONCLUSIONS
  Minimally invasive video-assisted MV surgery using deep hypothermia, low-flow cardiopulmonary bypass without aortic clamping can result in excellent clinical outcomes in patients with previous cardiac surgery via a median sternotomy. This technique offers reproducible results, good myocardial protection (as evidenced by the low rate of inotropic support that patients needed postoperatively), and low rates of complications.
authors.affiliation: Cardiovascular Surgery, Özel Adana Hastanesi, Hekimköy Sitesi Sarıçam D-5 No:108, 01000, Adana, Turkey. htkiziltan@yahoo.com.
authors.forename: H Tarık
authors.initials: HT
authors.lastname: Kızıltan
authors.affiliation: Anesthesiology and Reanimation, Özel Adana Hastanesi, Adana, Turkey. idemasli@hotmail.com.
authors.forename: Aslı
authors.initials: A
authors.lastname: İdem
authors.affiliation: Cardiovascular Surgery, Fatih University, Medical Faculty, Istanbul, Turkey. drsalihi@yahoo.com.
authors.forename: Salih
authors.initials: S
authors.lastname: Salihi
authors.affiliation: Cardiology, Fatih University, Medical Faculty, İstanbul, Turkey. asdemir@fatih.edu.com.
authors.forename: Ali Soner
authors.initials: AS
authors.lastname: Demir
authors.affiliation: Cardiovascular Surgery, Fatih University, Medical Faculty, Istanbul, Turkey. aakorkmaz@gmail.com.
authors.forename: Aşkın Ali
authors.initials: AA
authors.lastname: Korkmaz
authors.affiliation: Cardiovascular Surgery, Fatih University, Medical Faculty, Istanbul, Turkey. mguden1965@yahoo.com.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Güden
mesh_terms: D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods; D002315:Cardiopulmonary Bypass / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D058386:Mitral Valve Annuloplasty / Q000379:methods*; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000601:surgery*; D011475:Prosthesis Failure; D012086:Reoperation; D012189:Retrospective Studies; D013908:Thoracotomy / Q000379:methods; D020535:Video-Assisted Surgery / Q000379:methods