Objective To review and analyze minimally invasive right thoracotomy and peripheral cannulation as an alternative strategy in redo heart surgery.Methods From June 2012 to December 2016, 23 reoperative heart procedures were performed through a right lateral thoracotomy with about 5 cm in the third or fourth intercostal space,according to the different diagnosis with the corresponding operations.Results We performed 23 redo heart surgeries,there were 10 female and 13 male patients with a mean age of 41.43 years(range,20 to 69 years).4 mitral perivalvular leakage, 1 prosthetic valve dysfunction, 3 mitral insufficiency after mitral valvuloplasty, 1 aortic insufficiency after ventricular septal defect and aortic repair, 1 mitral insufficiency after ventricular and atrial septal defect repair, 3 residual fistula after surgery repair of ventricular septal defect, 1 tricuspid insufficiency after mitral and aortic valve replacement, 1 tricuspid insufficiency after left atrial myxoma removal,1 tricuspid insufficiency after Bentall surgery, 2 tricuspid insufficiency after mitral valve replacement, 1 mitral insufficiency after ventricular septal defect and mitral valvuloplasty, 2 tricuspid insufficiency after the repair of Ebstein abnormality.We respectively carried out repair of valve leakage, mitral valve replacement, aortic valve replacement, mitral valve repair, tricuspid valvuloplasty, postoperative repair of residual shunt of ventricular septal defect, redo repair of Ebstein abnormality.The effect of the whole group operation of operation was satisfactory, no death during operation and severe complications.All patients were under cardiopulmonary bypass,three patients' ascending aortas were bloked, and nine patients were with cardiopulmonary bypass.It indicated tha the operation was possible at operation time,total blood loss and the frequency of blood transfusion.Conclusion The application of closed thoracic cardiopulmonary bypass and minimally invasive right thoracotomy in redo or multiple cardiac surgery,can avoid reoperative sternotomy risk such as hemorrhage, tissue damage and so on.It shortened the operation time, reduced the risk of surgery and blood transfusion rate, can be used in some of the heart surgery patients again and repeatedly.

Objective Some major procedures for DeBakey type Ⅰ aortic dissection used to be performed with deep hypothermic circulatory arrest, which had been associated with more complications than seen with standard extracorporeal circulation. We reviewed the cases who received the treatment for DeBakey type Ⅰ aortic dissection by hybrid procedure without deep hypothermic circulatory arrest. The procedure consisted of ascending aorta replacement, ascending aorta-aortic arch branch vascular bypass reconstruction and endovascular graft exclusion. Methods From January 2009 to June 2010, 39 patients [mean age (55 ±16) years] who had DeBakey Ⅰ aortic dissection underwent hybrid procedure without deep hypothermic circulatory arrest. The femoral artery and right axillary artery were cannulated for perfusion. The ascending aorta and/or aortic valves were replaced under conventional extracorporeal circulation with Bentall procedure or Wheat procedure. The aortic arch branch vessels were dissected and the proximal part was sealed. Then the ascending aorta-aortic arch branch vascular bypasses were constructed with 4-bifurcation vascular grafts, Y-shape bifurcated vascular grafts or artificial vessels. Finally the endovascular grafts were deployed via the femoral incisions monitored dynamically with DSA, or via the ascending aortic bifurcated vessels monitored with transesophageal echocardiography. Results The operation succeeded in all 39 patients. Eight patients underwent ascending aorta replacement without aortic valve replacement or prosthesis, 20 patients underwent Bentall procedure ( Carbrol procedure were used in 11 cases), and 11 underwent Wheat procedure. For ascending aorta-aortic branch vascular bypass reconstruction, sequential anastomoses were performed in 8, Y-shaped bifurcated grafts were used in 15, and 4-bifurcated grafts were employed in 16 patients. The endovascular stent grafts were deployed via the former femoral incisions in 36 patients and via ascending aortic bifurcated vessels in 3. The cardiopulmonary bypass time was (61 ±22) minutes, the aortic crossclamp time was (48 ±18) minutes, and the post-operative intubation time was (30 ±9) hours. The thoracic drainage from each patient was less than 300 ml in 24 hours. No complication, such as hemiplegia, paraplegia, severe infections, renal failure or coagulation disorder, was observed. The duration of hospitalization was (21 ±6) days. No hospital death occurred. Follow-up was performed 1 to 15 months [mean (8.4 ±7.2) months] postoperatively. All patients survived without any organ dysfunction at follow up. The CTA examination 3 months after operation revealed that the false lumens had been closed in 91.2% of the patients. Conclusion Our findings indicated that the hybrid procedure, which combining ascending aorta replacement,ascending aorta-aortic arch branch vascular bypass reconstruction and endovascular graft exclusion under conventional extracorporeal circulation, may be an option for avoiding the possible complications associated with profound hypothermic circulatory arrest. The novel hybrid operation may improve the surgical outcomes and provide a simplified surgical approach for the treatment of DeBakey Ⅰ aortic dissection.