Minimally invasive mitral valve reconstruction on the fibrillating heart for high-risk patients.

BACKGROUND AND AIM OF THE STUDY: Mitral valve surgery after previous cardiac surgery is technically demanding and risky. In patients after coronary artery bypass grafting (CABG), mitral valve surgery is associated with a high risk of injury to the bypass graft with concomitant myocardial ischemia. An aortic valve prosthesis usually severely impairs access to the mitral valve, so that these patients are often denied surgery. Furthermore, patients with porcelain aorta may be inoperable.

METHODS

A series of 10 patients undergoing minimally invasive mitral valve repair via a right-sided anterolateral minithoracotomy without aortic cross-clamping on the fibrillating heart was investigated. Four patients had an aortic valve prosthesis in situ, six patients had undergone previous CABG, and two patients presented with porcelain aorta.

RESULTS

Reconstruction was possible in nine patients. Cannulation was performed femorally in three patients, and via the axillary artery in seven patients. No fatalities were observed. One patient required rethoracotomy for bleeding and subsequently developed a right-sided pneumonia, and a second patient experienced lower-limb ischemia. The postoperative course of the other eight patients was uneventful. No patient presented with significant residual mitral insufficiency at control echocardiography.

CONCLUSION

Minimally invasive mitral valve reconstruction via a right-sided minithoracotomy represents an attractive surgical option in a high-risk reoperative setting.