PMID- 10543461
OWN - NLM
STAT- MEDLINE
DCOM- 19991214
LR  - 20190921
IS  - 0886-0440 (Print)
IS  - 0886-0440 (Linking)
VI  - 13
IP  - 6
DP  - 1998 Nov-Dec
TI  - Mini-reoperative mitral valve surgery.
PG  - 468-70
AB  - BACKGROUND: Reoperative surgery involving the atrioventricular valves places the 
      patient at risk for cardiac or bypass graft injury upon reoperative sternotomy. 
      Standard right thoracotomy can avoid these problems but is associated with a 
      large incision and possibly more pulmonary complications. METHODS AND RESULTS: An 
      alternative, minimally invasive approach for reoperative atrioventricular valve 
      surgery was studied in 22 patients. Patient age was 66 +/- 10 years. 
      Postoperative mitral regurgitation was 3.4 +/- 0.3 and New York Heart Association 
      (NYHA) Class was III/IV, despite a mean ejection fraction of 44 +/- 14%. These 
      patients had 1-4 prior procedures a mean of 5 years previously. An anterior 5th 
      interspace incision of 5- to 10-cm was performed. A 1-cm segment of 5th rib was 
      removed to facilitate exposure. Cardiopulmonary bypass was performed via 
      ascending aorta or femoral artery cannula and bicaval venous cannulae. Systemic 
      cooling (25 degrees) and fibrillatory arrest was used. Operations performed 
      included mitral valve repair (12), mitral valve replacement (5), prosthetic 
      mitral valve rereplacement (4), repair of perivalvular leak (3), tricuspid valve 
      repair (5), and atrial septal defect closures (7). Mean bypass time was 109 +/- 
      21 minutes with a mean fibrillatory time of 62 +/- 12 minutes. There was no 
      intraoperative or 30-day mortality. Patients were weaned from ventilation at a 
      mean of 5 hours postoperatively and received 1.3 +/- 1 unit of blood. There were 
      no wound complications or re-explorations for bleeding. At a mean follow-up of 15 
      +/- 8 months, survivors are NYHA Class I-II. When interviewed, all patients felt 
      their recovery was more rapid and less painful than their original sternotomy. 
      CONCLUSION: This minimally invasive approach to reoperative atrioventricular 
      valve surgery is safe and technically feasible. It has become our preferred 
      approach to the atrioventricular valves in patients with a previous sternotomy.
FAU - Vleissis, A A
AU  - Vleissis AA
AD  - Heart Institute, St. Vincent Hospital and Medical Center, Portland, Oregon, USA. 
      avlessis@yahoo.com
FAU - Bolling, S F
AU  - Bolling SF
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Card Surg
JT  - Journal of cardiac surgery
JID - 8908809
SB  - IM
MH  - Aged
MH  - Cardiac Surgical Procedures/methods
MH  - Cardiopulmonary Bypass
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Minimally Invasive Surgical Procedures/*methods
MH  - Mitral Valve/*surgery
MH  - Mitral Valve Insufficiency/mortality/physiopathology/*surgery
MH  - Postoperative Care
MH  - Reoperation/methods
MH  - Risk Factors
MH  - Stroke Volume
MH  - Survival Analysis
MH  - Tricuspid Valve/surgery
EDAT- 1999/10/30 00:00
MHDA- 1999/10/30 00:01
CRDT- 1999/10/30 00:00
PHST- 1999/10/30 00:00 [pubmed]
PHST- 1999/10/30 00:01 [medline]
PHST- 1999/10/30 00:00 [entrez]
AID - 10.1111/j.1540-8191.1998.tb01084.x [doi]
PST - ppublish
SO  - J Card Surg. 1998 Nov-Dec;13(6):468-70. doi: 10.1111/j.1540-8191.1998.tb01084.x.