title: Redo mitral valve replacement through a right mini-thoracotomy with an unclamped aorta.
abstract: Redo cardiac surgery represents a clinical challenge due to a higher rate of perioperative morbidity and mortality. Mitral valve (MV) re operations can particularly be demanding in patients with patent coronary grafts, previous aortic valve replacement, calcified aorta or complications following a previous operation (abscesses, leaks or thrombosis). In this article we describe our technique to manage complex mitral reoperations using a minimally invasive approach, moderate hypothermia and avoiding aortic cross-clamping. Minimally invasive procedures with an unclamped aorta have the potential to combine the benefits of less invasive access and continuous myocardial perfusion. The advantage of a right mini-thoracotomy is the avoidance of sternal re-entry and limited dissection of adhesions, reducing the risk of cardiac structures or patent graft injury. Moderate hypothermia and continuous blood perfusion can guarantee adequate myocardial protection particularly in the case of patent grafts, decreasing the dangers of an incomplete or imperfect aortic clamping at mild hypothermia and potential lesions due to demanding clamp placing. Complex MV reoperations can be safely and effectively performed through a smaller right thoracotomy in the fourth intercostal space with an unclamped aorta.
authors.affiliation: Cardiac Surgery Unit, Cardio-Thoraco-Vascular Department, Niguarda Cà Granda Hospital, Milan, Italy allucbot@tiscali.it luca.botta@ospedaleniguarda.it.
authors.forename: Luca
authors.initials: L
authors.lastname: Botta
authors.affiliation: Cardiac Surgery Unit, Cardio-Thoraco-Vascular Department, Niguarda Cà Granda Hospital, Milan, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Fratto
authors.affiliation: Cardiac Surgery Unit, Cardio-Thoraco-Vascular Department, Niguarda Cà Granda Hospital, Milan, Italy.
authors.forename: Aldo
authors.initials: A
authors.lastname: Cannata
authors.affiliation: Cardiac Surgery Unit, Cardio-Thoraco-Vascular Department, Niguarda Cà Granda Hospital, Milan, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bruschi
authors.affiliation: Cardiac Surgery Unit, Cardio-Thoraco-Vascular Department, Niguarda Cà Granda Hospital, Milan, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Merlanti
authors.affiliation: Cardiac Perfusion, Cardio-Thoraco-Vascular Department, Niguarda Cà Granda Hospital, Milan, Italy.
authors.forename: Christian
authors.initials: C
authors.lastname: Brignani
authors.affiliation: Cardiac Perfusion, Cardio-Thoraco-Vascular Department, Niguarda Cà Granda Hospital, Milan, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Bosi
authors.affiliation: Cardiac Surgery Unit, Cardio-Thoraco-Vascular Department, Niguarda Cà Granda Hospital, Milan, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Martinelli
mesh_terms: D000368:Aged; D001011:Aorta / Q000601:surgery; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D008943:Mitral Valve / Q000601:surgery*; D011183:Postoperative Complications; D012086:Reoperation; D013525:Surgical Instruments; D013908:Thoracotomy / Q000009:adverse effects / Q000379:methods*
keywords: Minimally invasive surgery; Mitral valve; Reoperation; Unclamped aorta