Initial Experience with Beating Heart Mitral Valve Repair via Mini-thoracotomy at a Single Institution

Teruya Nakamura	Hironori Izutani	Naosumi Sekiya
Hirotada Masuda and Yoshiki Sawa

（Department of Cardiovascular Surgery, NHO Kure Medical Center and Chugoku Cancer Center, Kure, Japan, Department of Cardiovascular and Thoracic Surgery, Ehime University Graduate School of Medicine, Toon, Japan, and Department of Cardiovascular Surgery, Osaka University of Graduate School of Medicine, Suita, Japan）

Mitral valve reoperation through a median sternotomy is technically challenging and carries higher postoperative morbidity and mortality than the primary operation, especially for a patient with patent coronary bypass grafts. We here present 3 cases of mitral valve reoperation using the beating heart technique under normothermic cardiopulmonary bypass via a mini-thoracotomy. The reasons that precluded sternal reentry were as follows:previous coronary bypass and patent internal mammary artery grafts in 2 cases, and a history of mediastinal wound infection at the initial operation in 1 case. All cases were carried out via right mini-thoracotomy and cardiopulmonary bypass using arterial cannulation via the ascending aorta or the femoral artery, and venous cannulation via the femoral vein and the superior vena cava. Mitral valve repair was performed for 1 case, and valve replacement for 2 cases. Transfusion was not necessary, except for 1 case that had anemia due to hemolysis preoperatively. All patients were discharged without major complications. This technique is a safe and feasible option for a mitral valve reoperation that excludes re-sternotomy, extensive pericardial dissection and aortic clamping, thereby minimizing risks of bleeding, graft injury and myocardial damage.

　

Jpn. J. Cardiovasc. Surg. 43:58-61（2014）

Keywords：mitral valve insufficiency;mitral valve repair;Reoperation;minimally invasive surgical procedures