title: Late redo-port access surgery after port access surgery.
abstract: OBJECTIVE
  This study presents the first report on short- and long-term outcomes in redo-port access surgery after previous port access surgery (redo-PAS-PAS) for new or recurrent mitral valve (MV) and tricuspid valve (TV) disease.
  
  
  METHODS
  Our current surgical team performed redo-PAS-PAS in 26 consecutive patients who had previous port access surgery (mean age 65.8 ± 13.3 years, 46.2% female, 42.3% older than 70 years, mean logistical EuroSCORE 22.5 ± 21.6%) between 1 February 1997 and 30 June 2014. Surgical indications included among others MV prosthesis dysfunction (n = 8, 30.8%), endocarditis (n = 10, 38.5%) and TV dysfunction (n = 3, 11.5%). The mean time interval between primary PAS and redo-PAS-PAS was 70.32 ± 57.4 months.
  
  
  RESULTS
  Redo-PAS-PAS procedures included MV replacement (n = 19, 73.1%), MV repair (n = 5, 19.2%), and TV repair (n = 2, 7.7%). Sternotomy conversion was required in 5 patients (19.2%), of which 4 (15.4%) were early conversions due to lung adhesion and 1 (3.8%) due to a late intraoperative complication. The mean cardiopulmonary bypass and cross-clamp times were 163.3 ± 57.9 and 101.2 ± 43.8 min, respectively. Postoperative mechanical ventilation longer than 72 h was required in 4 patients (15.4%). In-hospital morbidities included hospital-acquired pneumonia (n = 3, 11.5%), postoperative air leaks (n = 2, 7.7%) and revision for bleeding (n = 1, 3.8%). The mean length of hospital stay was 16.1 days. Long-term clinical and echocardiographic follow-up were 48.3 ± 39.2 and 44.6 ± 32.9 months, respectively. The Kaplan-Meier analyses for survival and freedom from mitral and tricuspid valve reintervention (n = 26) at 5 years were 83.9 and 95.8%, respectively, with 91.3% of surviving patients classified as being NYHA II or less. Echocardiographic follow-up showed no residual mitral regurgitation more than grade I in all redo mitral valve repairs and no paravalvular leak post-valve replacement.
  
  
  CONCLUSIONS
  Redo-PAS-PAS is our routine approach and we apply this strategy in the majority of patients who had previous port access surgery. The predicted procedure-related mortality, morbidities, patient satisfaction and long-term outcomes are favourable.
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium.
authors.forename: Johan
authors.initials: J
authors.lastname: van der Merwe
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium filip.casselman@olvz-aalst.be.
authors.forename: Filip
authors.initials: F
authors.lastname: Casselman
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium.
authors.forename: Bernard
authors.initials: B
authors.lastname: Stockman
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium.
authors.forename: Yvette
authors.initials: Y
authors.lastname: Vermeulen
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium.
authors.forename: Ivan
authors.initials: I
authors.lastname: Degrieck
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium.
authors.forename: Frank
authors.initials: F
authors.lastname: Van Praet
mesh_terms: D000368:Aged; D001530:Belgium / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008943:Mitral Valve / Q000601:surgery*; D012086:Reoperation; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014261:Tricuspid Valve / Q000601:surgery*
keywords: Mitral and tricuspid valve disease; Outcome; Redo minimally invasive cardiac surgery