Direct Aortic Cross-clamping In Redo Mitral Valve Surgery Via Right Mini-thoracotomy

Objective: Reoperative mitral valve surgery is burdened by a greater technical difficulty and a higher complications rate compared with first operation. When in a Heart Centre the minimally invasive surgery has become routine, its application to reoperations may represent the way to greatly reduce the surgical risk. The objective of our study is to assess results within the last year of technically difficult reoperations in 30 pts with mitral valve disease approached through a 5-7 cm right mini-thoracotomy with direct aortic cross clamping. Methods: Cardiopulmonary bypass was established by percutaneous cannulation of femoral vein (in addition to internal jugular vein in case of tricuspid concomitant surgery) and surgical cannulation of axillary or femoral artery. Aorta was partially exposed and directly cross-clamped by the same thoracotomy. Results: Patients enrolled had a median age 68 years (IQR I-III 61-75). Median time between last operation and reoperation was 7 years (IQR I-III 4-11): 13 patients underwent mitral valve repair, 17 patients mitral valve replacement and 6 of these also received tricuspid valve annuloplasty. Median Euroscore I was 8.5 (IQR I-III 6.1-12). Median cross-clamp time was 68 min (IQR I-III 51-86) and median cardiopulmonary bypass time was 88 min (IQR I-III 68.8-119). 3 patients had a postoperative renal failure requiring CVVH and 4 patients underwent surgical re-exploration for bleeding. There were 2 deaths at 30 day follow-up. Conclusions: Direct aortic cross-clamping in minimally invasive mitral valve surgery reoperations is a safe procedure. The use of less invasive techniques in mitral surgery reoperations may minimize morbidity and mortality.