Fifteen-year experience with minimally invasive approach for reoperations involving the mitral valve

Joseph M. Arcidi, Evelio Rodriguez, Joseph R. Elbeery, L. Wiley Nifong, Jimmy T. Efird, W. Randolph Chitwood

    Research output: Contribution to journalArticle

    42 Citations (Scopus)

    Abstract

    Objective: Reoperative sternotomy to address mitral valve pathology carries substantial risk, especially with patent bypass grafts or an aortic valve prosthesis. We previously reported our early experience with minimally invasive right thoracotomy and peripheral cannulation as an alternative strategy, and we recently reviewed our cumulative 15-year hospital outcomes with this approach. Methods: Between June 1996 and April 2010, we performed right minithoracotomy for reoperations involving the mitral valve on 167 patients, 85 (51%) of these since 2006. Seventy-one percent had undergone previous coronary artery bypass grafting and 38% a previous valve procedure. Fibrillatory arrest was used in 77% and aortic clamping and root cardioplegia in 23%. Nineteen procedures were performed with robotic assistance. Results: Mitral repair frequency increased during each 5-year interval of our experience (1996-2000, 43%; 2001-2005, 53%; 2006-2010, 72%; P = .019), including 80% of native mitral valves without stenosis. Concomitant procedure frequency, most commonly atrial fibrillation ablation, also increased during each 5-year interval (0%, 21%, 48%; P < .0001). Thirty-day mortality was 3.0% (5/167), 0% since 2005. There were no conversions to sternotomy or aortic dissections. Stroke, in 2.4% (4/167), was statistically unrelated to fibrillatory arrest. Increased New York Heart Association functional class (odds ratio, 5.6; 95% confidence interval 1.1-27.8; P = .037) was the only independent predictor of mortality in multivariable analysis. Conclusions: Our updated experience confirmed the effectiveness of minimally invasive right thoracotomy to treat mitral pathology while avoiding reoperative sternotomy risk. We found fibrillatory and cardioplegic arrest methods to be safe myocardial preservation strategies with this approach.

    Original languageEnglish (US)
    Pages (from-to)1062-1068
    Number of pages7
    JournalJournal of Thoracic and Cardiovascular Surgery
    Volume143
    Issue number5
    DOIs
    StatePublished - May 1 2012

    Fingerprint

    Mitral Valve
    Reoperation
    Sternotomy
    Thoracotomy
    Pathology
    Induced Heart Arrest
    Mortality
    Mitral Valve Stenosis
    Robotics
    Aortic Valve
    Constriction
    Coronary Artery Bypass
    Catheterization
    Atrial Fibrillation
    Prostheses and Implants
    Dissection
    Stroke
    Odds Ratio
    Confidence Intervals
    Transplants

    All Science Journal Classification (ASJC) codes

    • Cardiology and Cardiovascular Medicine
    • Surgery
    • Pulmonary and Respiratory Medicine

    Cite this

    Fifteen-year experience with minimally invasive approach for reoperations involving the mitral valve. / Arcidi, Joseph M.; Rodriguez, Evelio; Elbeery, Joseph R.; Nifong, L. Wiley; Efird, Jimmy T.; Chitwood, W. Randolph.

    In: Journal of Thoracic and Cardiovascular Surgery, Vol. 143, No. 5, 01.05.2012, p. 1062-1068.

    Research output: Contribution to journalArticle

    Arcidi, Joseph M. ; Rodriguez, Evelio ; Elbeery, Joseph R. ; Nifong, L. Wiley ; Efird, Jimmy T. ; Chitwood, W. Randolph. / Fifteen-year experience with minimally invasive approach for reoperations involving the mitral valve. In: Journal of Thoracic and Cardiovascular Surgery. 2012 ; Vol. 143, No. 5. pp. 1062-1068.
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    abstract = "Objective: Reoperative sternotomy to address mitral valve pathology carries substantial risk, especially with patent bypass grafts or an aortic valve prosthesis. We previously reported our early experience with minimally invasive right thoracotomy and peripheral cannulation as an alternative strategy, and we recently reviewed our cumulative 15-year hospital outcomes with this approach. Methods: Between June 1996 and April 2010, we performed right minithoracotomy for reoperations involving the mitral valve on 167 patients, 85 (51{\%}) of these since 2006. Seventy-one percent had undergone previous coronary artery bypass grafting and 38{\%} a previous valve procedure. Fibrillatory arrest was used in 77{\%} and aortic clamping and root cardioplegia in 23{\%}. Nineteen procedures were performed with robotic assistance. Results: Mitral repair frequency increased during each 5-year interval of our experience (1996-2000, 43{\%}; 2001-2005, 53{\%}; 2006-2010, 72{\%}; P = .019), including 80{\%} of native mitral valves without stenosis. Concomitant procedure frequency, most commonly atrial fibrillation ablation, also increased during each 5-year interval (0{\%}, 21{\%}, 48{\%}; P < .0001). Thirty-day mortality was 3.0{\%} (5/167), 0{\%} since 2005. There were no conversions to sternotomy or aortic dissections. Stroke, in 2.4{\%} (4/167), was statistically unrelated to fibrillatory arrest. Increased New York Heart Association functional class (odds ratio, 5.6; 95{\%} confidence interval 1.1-27.8; P = .037) was the only independent predictor of mortality in multivariable analysis. Conclusions: Our updated experience confirmed the effectiveness of minimally invasive right thoracotomy to treat mitral pathology while avoiding reoperative sternotomy risk. We found fibrillatory and cardioplegic arrest methods to be safe myocardial preservation strategies with this approach.",
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    AU - Efird, Jimmy T.

    AU - Chitwood, W. Randolph

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