title: Outcomes of Minimally Invasive Valve Surgery in Patients with Multiple Previous Cardiac Operations.
abstract: The study aim was to evaluate the outcomes of minimally invasive valve surgery, performed via a right anterior thoracotomy approach, in patients with a history of multiple (more than two) prior cardiac surgeries.
  
  
  
  A retrospective review was conducted of all minimally invasive valve operations performed in patients with a prior history of two or more cardiac surgeries, including coronary artery bypass grafting (CABG) and/or valve surgery, at the authors' institution between January 2008 and November 2014.
  
  
  
  A total of 38 consecutive patients (23 males, 15 females; mean age 65.8 ± 14.6 years) were identified. Nine patients (24%) had two prior CABG operations, 18 (47%) had more than two prior valve surgeries, and 11 (29%) had a cardiac operative history that included both CABG and valve surgery. A total of 34 (89.5%) isolated valve procedures was identified; these consisted of 24 (64%) mitral valve operations, nine (23.7%) aortic valve replacements, and one (0.3%) tricuspid valve repair. Four patients (10.5%) underwent combined mitral and tricuspid valve surgery. Postoperatively, two patients (5.3%) had cerebrovascular accidents, three (7.9%) required reoperation for bleeding, and three (7.9%) had acute kidney injury. The median hospital length of stay was 9.5 days (IQR: 7-16 days). The 30-day mortality was 7.9%. The cumulative survival at one year was 82%, and was 72% at five years.
  
  
  
  Minimally invasive reoperative valve surgery after multiple prior cardiac operations is safe and feasible, with good perioperative outcomes and mid-term survival.
authors.affiliation: Columbia University, Mount Sinai Heart Institute, Miami Beach FL, USA.
authors.forename: Orlando
authors.initials: O
authors.lastname: Santana
authors.affiliation: Columbia University, Mount Sinai Heart Institute, Miami Beach FL, USA.
authors.forename: Rama
authors.initials: R
authors.lastname: Krishna
authors.affiliation: Columbia University, Mount Sinai Heart Institute, Miami Beach FL, USA.
authors.forename: Nisharahmed
authors.initials: N
authors.lastname: Kherada
authors.affiliation: Massachusetts General Hospital, Boston MA, USA. Electronic correspondence: cmihos@mgh.harvard.edu.
authors.forename: Christos G
authors.initials: CG
authors.lastname: Mihos
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D001026:Coronary Artery Bypass; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery*; D006351:Heart Valves / Q000601:surgery*; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications; D012086:Reoperation / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome