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Heart - Lung (Varna)

Mitral valve reoperations through right thoracotomy approach

Vili Pashev, Plamen Panayotov, Delyan Evrev, Zheko Naychov, Lilyana Mircheva, Emil Yordanov, Veselin Petrov

Abstract

Cardiac surgery reoperations are related to an increased risk of rupture of heart structures, large vessels, and patent grafts during middle re-sternotomy due to adhesions around the heart and between the heart and the sternum. Right thoracotomy access is a good alternative to minimize possible complications in mitral valve redo surgery.

This report aims at presenting the results of two cases of redo-mitral valve replacement performed at the University Hospital "Lozenets" through right anterolateral thoracotomy access.

The first case is a 50-year-old woman with mechanical dysfunction of a mitral valve prosthesis with a high degree of obstruction, and the second is a 72-year-old male who has previously undergone left ventricle plastic due to aneurysm and mitral valve plasty.

In both patients, a computed tomographic study was performed before the operation showing the presence of adhesions between the sternum and heart. Both were operated on with a separate bronchial intubation with a Carlen's tube and right anterolateral thoracotomy at the 5th intercostal space. The mitral valve prosthesis was biological. No complications were observed during the surgery and in the postoperative period. Patients were discharged on the 17th and 14th postoperative days, respectively.

Keywords

reoperation; mitral valve; right thoracotomy

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References

Morales D, Williams E, John R. Is resternotomy in cardiac surgery still a problem? Interact Cardiovasc Thorac Surg 2010;11:277-86.

Kuralay E, Bolcal C, Cingoz F, Günay C, Yildirim V, Kilic S, Özal E, Demirkilic U, Arslan M, Tatar H. Cardiac reoperation by Carpentier bicaval femoral venous cannula: GATA experience, Ann Thorac Surg , 2004, vol. 77 (pg. 977-982)

Ungerleider RM, Mills ML, Wechsler AS. Left thoracotomy for reoperative coronary artery bypass procedures. Ann Thorac Surg 1985;40:11

Walker WS, Sang CTM. Avoidance of patent anterior grafts at revisional coronary artery surgery: use of a lateral thoracotomy approach, Thorax , 1986, vol. 41 (pg. 692-695)

Thompson MJ, Behranwala A, Campanella C, et al. Immediate and long term results of mitral prosthetic replacement using a right thoracotomy beating heart technique. Eur J Cardiothorac Surg 2003;24:47-51; discussion 51.

Cohn LH. Evolution of redo cardiac surgery: review of personal experience. J Card Surg 2004;19:320-4.

Vahanian A, Alfieri O, Andreotti F, et al. Guidelines on the management of valvular heart disease (version 2012): The Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur J Cardiothorac Surg 2012;42:S1-44.

Arcidi JM Jr, Rodriguez E, Elbeery JR, et al. Fifteen-year experience with minimally invasive approach for reoperations involving the mitral valve. J Thorac Cardiovasc Surg 2012;143:1062-8.

Murzi M, Kallushi E, Tiwari KK, et al. Minimally invasive mitral valve surgery through right thoracotomy in patients with patent coronary artery bypass graſts. Interact Cardiovasc Thorac Surg 2009;9:29-32.

Byrne JG, Karavas AN, Adams DH, et al. The preferred approach for mitral valve surgery after CABG: right thoracotomy, hypothermia and avoidance of LIMA-LAD graſt. J Heart Valve Dis 2001; 10:584-90.

Svensson LG, Gillinov AM, Blackstone EH, Houghtaling PL, Kim K-H, Pettersson GB, Smedira NG, Banbury MK, Lytle BW. Does right thoracotomy increase the risk of mitral valve reoperation?, J Thorac Cardiovasc Surg , 2007, vol. 134 (pg. 677-682)

Ricci D, Pellegrini C, Aiello M, et al. Port-access surgery as elective approach for mitral valve operation in re-do procedures. Eur J Cardiothorac Surg 2010;37:920-5.




DOI: http://dx.doi.org/10.14748/hl.v21i3-4.5165

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