title: A right thoracotomy approach for mitral and tricuspid valve surgery in patients with previous standard sternotomy: comparison with a re-sternotomy approach.
abstract: BACKGROUND
  To compare the outcomes of mitral and/or tricuspid valve surgery in patients with previous sternotomy between those who underwent a right thoracotomy and those who underwent re-sternotomy.
  
  
  METHODS
  Between October 2009 and May 2015, eighteen patients underwent a right thoracotomy (R group) and 28 underwent re-sternotomy (re-S group). The right thoracotomy was prioritized for previous coronary artery bypass grafting. Follow-up was 100 % complete with a mean follow-up of 1.9 ± 1.5 years for the R group and 2.5 ± 1.4 years for the re-S group (p = 0.2137).
  
  
  RESULTS
  Hypothermic ventricular fibrillation was applied in 33.3 % in the R group and in 7.1 % in the re-S group (p = 0.0424). Hospital mortality, the median intensive care unit stay, and the median postoperative hospital stay were 0 % versus 7.1 % (p = 0.5130), 3 days versus 2 days (p = 0.2370), and 28 days versus 29.5 days (p = 0.8043) for the R group versus the re-S group, respectively. Although the rate of major complications was comparable (R group 33.3 % versus re-S group 25.0 %, p = 0.5401), those contents were not equal. Deep sternum infection developed only in the re-S group (3.6 %) and reoperation for bleeding was required only in the R group (11.1 %). No significant difference was observed in the 2-year cardiac-related mortality-free rate (R group 93.3 ± 6.4 % versus re-S group 90.8 ± 6.4 %, p = 0.7516).
  
  
  CONCLUSIONS
  Given study limitations, the right thoracotomy approach after previous sternotomy provided favorable outcomes as well as re-sternotomy. When selecting a right thoracotomy for re-do mitral and/or tricuspid surgery, the surgical strategy needs to be thoroughly planned.
authors.affiliation: Department of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan. takashiren@yahoo.co.jp.
authors.forename: Takashi
authors.initials: T
authors.lastname: Miura
authors.affiliation: Department of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan.
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Tanigawa
authors.affiliation: Department of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Matsukuma
authors.affiliation: Department of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Matsumaru
authors.affiliation: Department of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan.
authors.forename: Kazuki
authors.initials: K
authors.lastname: Hisatomi
authors.affiliation: Department of Cardiovascular Surgery, Sasebo General Hospital, Nagasaki, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Hazama
authors.affiliation: Department of Cardiology, Nagasaki University Hospital, Nagasaki, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Tsuneto
authors.affiliation: Department of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan.
authors.forename: Kiyoyuki
authors.initials: K
authors.lastname: Eishi
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods / Q000401:mortality; D005260:Female; D006324:Heart Arrest, Induced / Q000379:methods; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008943:Mitral Valve / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D012086:Reoperation; D056346:Sternotomy / Q000379:methods* / Q000401:mortality; D013249:Sternum / Q000601:surgery; D013908:Thoracotomy / Q000379:methods* / Q000401:mortality; D014261:Tricuspid Valve / Q000601:surgery; D014262:Tricuspid Valve Insufficiency / Q000401:mortality / Q000601:surgery*
keywords: Minimally invasive valve surgery; Previous standard sternotomy; Reoperation; Right thoracotomy; Standard re-sternotomy