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Naresh Trehan
Yugal K Mishra
Satish G Mathew
Yatin Mehta
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Right arrow Minimally invasive surgery
Asian Cardiovasc Thorac Ann 2002;10:215-218
© 2002 Asia Publishing EXchange Pte Ltd

ORIGINAL CONTRIBUTIONS

Redo Mitral Valve Surgery Using the Port-Access System

Naresh Trehan, MD, Yugal K Mishra, PhD, Satish G Mathew, MCh, Krishna K Sharma, MD1, Sameer Shrivastava, DM2, Yatin Mehta, MD1

Department of Cardiovascular Surgery
1 Department of Anaesthesiology
2 Department of Cardiology Escorts Heart Institute and Research Centre New Delhi, India
For reprint information contact: Yugal K Mishra, PhD Tel: 91 11 682 5000 Fax: 91 11 682 5013 email: dryugal{at}mantramail.com Department of Cardiovascular Surgery, Escorts Heart Institute and Research Centre, Okhla Road, New Delhi 110025, India.
Redo mitral valve surgery is hazardous, hence we explored an alternative approach using a port-access system that avoids reentry. Between October 1997 and December 2000, 32 patients underwent mitral reoperation using the system. All patients had previous cardiac operations. This procedure consisted of a right anterolateral minithoracotomy and femorofemoral cannulation using special port-access instruments and endoaortic clamping in 24 patients or direct transthoracic sliding-rod aortic clamping in 8. The valve disease was of rheumatic etiology in 28 patients and degenerative in 4. The valve was replaced in 31 cases and a paravalvular leak after mitral valve replacement was closed in 1. In 2 cases, the tricuspid valve was repaired along with mitral valve replacement. Mean total operating time was 4.5 ± 1.2 hours, cardiopulmonary bypass time 162 ± 72 minutes, and aortic crossclamp time 62 ± 21 minutes. There was no mortality, and mean stay in the intensive care unit was 22 ± 7 hours and hospital stay 6.4 ± 1.2 days. Postoperative blood transfusion was required in 12 patients. In view of the favorable results, we recommend using the port-access system as a standard approach for mitral reoperation.




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