Left Thoracotomy for Multiple-Time Redo Mitral Valve Surgery Using On-Pump Beating Heart Technique

Background There are limited reports describing multiple-time redo mitral valve surgery using a left thoracotomy approach and on-pump beating heart technique. Methods A retrospective review of medical records for 16 patients from March 2002 to June 2007 was performed. Results Mean age was 54 ± 17 (mean ± SD) years (8 males). Preoperative mitral valve regurgitation was 3.6 ± 0.6 in 14, and 2 had severe mitral valve stenosis. New York Heart Association symptom class was 2.9 ± 1.0 and ejection fraction was 0.4 ± 0.15 (range, 0.2 to 0.6). Previous cardiac operations were performed twice in 14 and three times in 2 patients with an interval of 4.8 ± 5.5 years since the last. The procedures included repair (5), replacement (8), and re-replacement (3). All were performed through a fifth intercostal space, left posterolateral thoracotomy with the heart beating on cardiopulmonary bypass (32 to 37°C). Left femoral artery or descending thoracic aorta inflow and left femoral vein or left main pulmonary artery venous drainage with vacuum assist were used. Operation time was 221 ± 51 minutes and cardiopulmonary bypass time was 71 ± 27 minutes. Postoperative ventilation time was 10.0 ± 7.7 hours, intensive care unit stay was 2.9 ± 1.9 days, and hospital stay was 6.2 ± 2.4 days. There were two 30-day mortalities and two died late with a follow-up of 30 ± 22 months. Conclusions Left thoracotomy using the on-pump beating heart technique is safe, effective, and should be considered for multiple-time redo mitral valve surgery.