P45 minithoracotomy approach for mitral valve redo surgery

Objective Redo cardiac surgery through median sternotomy still represents a challenging procedure due to the high risk of graft injuries, the presence of dense adhesions and complex valve exposure. The use of a minithoracotomy approach may reduce the surgical complexity. We report our experience performing redo mitral valve surgery through a right–sided mini–thoracotomy. Methods From march 2010 to May 2022, 58 patients (Median age 68 years (IQR 56–76) and 41.4% females) underwent redo mitral valve surgery through right anterior thoracotomy at our institution. Median EuroSCORE II was 3.83 (IQR 2.54–7.28). Results The median time from the original operation to redo surgery was 6.1 (1.0–10.3) years. First surgery was mitral repair in 60% of patients, mitral valve replacement in 15%, Coronary Artery Bypass Grafting in 12% and Aortic valve Replacement in nearly 9% of our population. Four patients (6.9%) were affected by active endocarditis at the time of surgery. Median cardiopulmonary bypass and cross–clamp times were 120 (IQR 80–148) minutes and 81 (IQR 59.5–114) minutes, respectively. No conversion to full sternotomy was necessary. Twenty–eight patients (48.3%) required transfusions with packed blood cells. Post–operative atrial fibrillation was observed in 6 patients (10.3%) and 7 patient (12.1%) required Pace–maker implantation due to third degree AV block. Moreover, we observed 1 rethoracotomy for bleeding (1.7%). One patient (1.7%) required re–intubation, dialysis and Extracorporeal Life Support, for a septic shock that finally caused exitus. Median ventilation time was 7 hours (IQR 4–13). Median ICU and in–hospital length of stay were 2 (IQR 2–3) days and 10 (IQR 8–15) days respectively. In–hospital and 30–days mortality was 1.7%. Conclusions In our experience, a minimally invasive approach through right thoracotomy for redo mitral valve procedures is safe and feasible, with acceptable CPB and Cross–clamp times and good in–hospital outcomes. Therefore, it can be an attractive option for patients with previous cardiac surgery, above all for patients with patent grafts. Further studies are needed with a bigger population and a comparison to full sternotomy results.