Mitral Valve Surgery via a Right Infra-axillary Thoracotomy in High-Risk Reoperative Patients
DOI:
https://doi.org/10.1532/hsf.2897Abstract
Background: A right infra-axillary thoracotomy can offer excellent exposure of the mitral valve. This study evaluated this incision for high-risk patients undergoing redo mitral valve procedures.
Methods: Of a series of 189 patients who had redo mitral valve surgery, 32 were reoperated via vertical infra-axillary thoracotomy based on previous aortic valve replacement, dense adhesion, location of patent bypass grafts, and peripheral vascular disease.
Results: Sternotomy was avoided in all cases. The mitral valve was replaced in 22 patients and repaired in 10 patients; left atrial folding was performed in 6 patients. All patients had uneventful outcomes and normal valve function
during follow-up.
Conclusions: Reoperative mitral valve surgeries can be performed safely using right infra-axillary thoracotomy in certain patients. The procedure offers excellent exposure of the mitral valve and minimizes the need for cardiac dissection, thus reducing injury risk. Avoiding a high risk of resternotomy increases patient comfort and safety.
References
Bolotin G, Kypson AP, Reade CC, et al. 2004. Should a video-assisted mini-thoracotomy be the approach of choice for reoperative mitral valvesurgery? J Heart Valve Dis 13:155-158.
Cao H, Zhou Q, Fan F, Xue Y, Pan J, Wang D. 2017. Right anterolateral thoracotomy: An attractive alternative to repeat sternotomy for high-risk patients undergoing reoperative mitral and tricuspid valve surgery. J Cardiothorac Surg 12:85.
Casselman FPCasselman FP, La Meir MLa Meir M, Jeanmart HJeanmart H, et al. 2007. Endoscopic mitral and tricuspid valve surgery after previous cardiac surgery. Circulation 116:I270-I275.
Ellman PI, Smith RL, Girotti ME, et al. 2008. Cardiac injury during resternotomy does not affect perioperative mortality. J Am Coll Surg 206:993-997.
Ghoreishi M, Dawood M, Hobbs G, et al. 2013. Repeat sternotomy: No longer a risk factor in mitral valve surgical procedures. Ann Thorac Surg 96:1358-1365.
Holzhey DM, Seeburger J, Misfeld M, Borger MA, Mohr FW. 2013. Learning minimally invasive mitral valve surgery: A cumulative sum sequential probability analysis of 3895 operations from a single high-volume center. Circulation 128:483-491.
Keenan NM, Bennetts JS, McGavigan AD, et al. 2019. Transcatheter transseptal mitral valve-in-valve replacement: An early Australian case series and literature review. Heart Lung Circ S1443-9506:31373-31373.
Luo H, Wang J, Qiao C, Zhang X, Zhang W, Song L. 2014. Evaluation of different minimally invasive techniques in the surgical treatment of atrial septal defect. J Thorac Cardiovasc Surg 148:188-193.
Onnasch JF, Schneider F, Falk V, Mierzwa M, Bucerius J, Mohr FW. 2002. Five years of less invasive mitral valve surgery: From experimental to routine approach. Heart Surg Forum 5:132-135.
Park CB, Suri RM, Burkhart HM, et al. 2010. Identifying patients at particular risk of injury during repeat sternotomy: Analysis of 2555 cardiac reoperations. J Thorac Cardiovasc Surg 140:1028-1035.
Patel H, Lewis CTP, Stephens RL, Angelillo M, Sibley DH. 2017. Minimally invasive redo mitral valve replacement using a robotic-assisted approach. Innovations (Phila) 12:375-377.
Patel NC, Hemli JM, Seetharam K, et al. 2019. Reoperative mitral valve surgery via sternotomy or right thoracotomy: A propensity-matched analysis. J Card Surg 34:976-982.
Roselli EE, Pettersson GB, Blackstone EH, et al. 2008. Adverse events during reoperative cardiac surgery: Frequency, characterization, and rescue. J Thorac Cardiovasc Surg 135:316-323.
Wang D, Wang Q, Yang X, Wu Q, Li Q. 2009. Mitral valve replacement through a minimal right vertical infra-axillary thoracotomy versus standard median sternotomy. Ann Thorac Surg 87:704-708.
Wang Q, Ye JX, Ge M, Wang DJ. 2018. Early- and long-term outcomes of cardiovascular surgery via minimal right vertical infra-axillary thoracotomy: A 15-year study of 1,126 patients. Sci Rep 28:4376.
Wu Z, Pan J, Wang Q, Zhou Q, Wang D. 2012. Surgical repair of mitral valve prolapse through a minimal right vertical infraaxillary thoracotomy. J Card Surg 27:533-537.
Xu C, Pan J, Zhou Q, et al. 2015. Right vertical infra-axillary thoracotomy for double valve replacement. J Card Surg 30:427-430.
Yaliniz H, Topcuoglu MS, Gocen U, et al. 2015. Comparison between minimal right vertical infra-axillary thoracotomy and standard median sternotomy for repair of atrial septal defects. Asian J Surg 38:199-204.
