MC41. Reoperative mitral valve surgery via right mini-thoracotomy: the safer and more effective way

Background: Re-operative mitral valve surgery is sometimes burdened by a greater technical difficulty and a higher complications rate than the first operation. Minimally invasive cardiac surgery has become routine, and it could significantly reduce the surgical risk in redo surgery.
Methods: From February 2017 to December 2021, 85 patients underwent re-operative mitral valve surgery in our institution. Cardiopulmonary bypass was started by cannulation of the femoral and jugular vein and femoral artery or alternatively right axillary artery. Patients enrolled had a mean age of 65±11.3 years. Patients were divided into three groups based on the procedure adopted: External aortic cross-clamp, EndoAortic balloon occlusion and ventricular fibrillation (VF). Major complications were evaluated and compared with a propensity matched population of patients undergoing elective isolated mitral valve surgery via right minithoracotomy.
Results: The average time between last operation and reoperation was 7.5±3.9 years. Nineteen patients (20%) underwent mitral valve repair and 76 patients (80%) underwent mitral valve replacement; 12 patients (11,4%) received tricuspid valve surgery. There was no statistically significant difference in CPB time between the groups. 7 patients (6.65%) had a postoperative renal failure, 7 patients (6.65%) underwent surgical reopening for bleeding; incidence of post-operative stroke and pace-maker implantation was 3.1% for both. No deaths were registered during in-hospital stay and at 30-days echocardiographic control all patients respect the criterions of device success according with MVARC. Propensity matched patients of group redo had a longer cardiopulmonary bypass time (10178 ± 50.7 min versus 70.8 ± 17.7, p < 0.001) and cross-clamp time (69.9 ± 31.7 min versus 61.1 ± 10.1 min, p < 0.001) respect to first operation mitral valve surgery patients.
Conclusions: minimally invasive mitral valve redo surgery is a safe procedure. Less invasive techniques in redo surgery could minimize morbidity and mortality without prolonging the duration of cardiopulmonary bypass.

Prestipino Filippo (1), riccardo d'ascoli (2), gianluca paternoster (2), erica manzan (2), mariassunta telesca (3), Pasquale Innelli (3), (1) San Carlo Potenza, potenza, Italy, (2) AOR San Carlo Potenza - Italy, potenza, italy, (3) AOR San Carlo, potenza, italy

Prestipino Filippo

Poster Presenter

Filippo Prestipino MD

Cardiac Surgeon 

Cardiocascular Department

San Carlo Hospital 

Basilicata - Italy

Specialties: Adult Cardiac, Mitral Valve, Anatomy and Conditions, Valve, Mitral Valve, Treatment/Procedure/Operation/Surgery, Valve, Mitral Valve