Initial Experience with Beating Heart Mitral Valve Repair via Mini-thoracotomy at a Single Institution
10.4326/jjcvs.43.58
- VernacularTitle:右小開胸による心拍動下僧帽弁再手術の経験
- Author:
Teruya Nakamura
;
Hironori Izutani
;
Naosumi Sekiya
;
Hirotada Masuda
;
Yoshiki Sawa
- Publication Type:Journal Article
- Keywords:
mitral valve insufficiency;
mitral valve repair;
reoperation;
minimally invasive surgical procedures
- From:Japanese Journal of Cardiovascular Surgery
2014;43(2):58-61
- CountryJapan
- Language:Japanese
-
Abstract:
Mitral valve reoperation through a median sternotomy is technically challenging and carries higher postoperative morbidity and mortality than the primary operation, especially for a patient with patent coronary bypass grafts. We here present 3 cases of mitral valve reoperation using the beating heart technique under normothermic cardiopulmonary bypass via a mini-thoracotomy. The reasons that precluded sternal reentry were as follows : previous coronary bypass and patent internal mammary artery grafts in 2 cases, and a history of mediastinal wound infection at the initial operation in 1 case. All cases were carried out via right mini-thoracotomy and cardiopulmonary bypass using arterial cannulation via the ascending aorta or the femoral artery, and venous cannulation via the femoral vein and the superior vena cava. Mitral valve repair was performed for 1 case, and valve replacement for 2 cases. Transfusion was not necessary, except for 1 case that had anemia due to hemolysis preoperatively. All patients were discharged without major complications. This technique is a safe and feasible option for a mitral valve reoperation that excludes re-sternotomy, extensive pericardial dissection and aortic clamping, thereby minimizing risks of bleeding, graft injury and myocardial damage.
