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  • Title: Beating Heart Minimally Invasive Mitral Valve Surgery in Patients With Patent Coronary Bypass Grafts.
    Author: Ghoneim A, Bouhout I, Mazine A, Fortin W, El-Hamamsy I, Jeanmart H, Pellerin M, Bouchard D.
    Journal: Can J Cardiol; 2016 Aug; 32(8):987.e1-6. PubMed ID: 26838664.
    Abstract:
    BACKGROUND: Redo mitral valve surgery in patients with patent coronary bypass grafts carries a risk of graft injury and postoperative bleeding. We compare early results of reoperative minimally invasive on-pump beating heart mitral valve surgery (OPBMS) via mini thoracotomy vs the results of standard sternotomy mitral valve surgery (SSMS) in the presence of patent coronary bypass grafts. METHODS: Between 2009 and 2015, 12 patients underwent OPBMS through a right mini thoracotomy and 6 patients underwent SSMS. All patients had at least 1 patent bypass graft. RESULTS: Median age and EuroSCORE II were not statistically different between the 2 groups. There was no early death in the OPBMS group vs 1 death (17%) in the SSMS group. There was a statistically significant lower median perioperative blood loss in the OPBMS group compared with the SSMS group (200 vs 650 mL; P = 0.005). Four patients (33%) in the OPBMS group required blood transfusion compared with 4 in the SSMS group (67%; P = 0.32). There was 1 perioperative stroke (17%) and 1 acute myocardial infarction (17%) in the SSMS group. Four patients developed acute renal failure in the OPBMS group compared with 3 in the SSMS group (50%; P = 0.62). The predischarge transthoracic echocardiogram showed ≤ 1 mitral regurgitation in all patients. CONCLUSIONS: Redo mitral surgery in patients with patent bypass grafts can safely be performed via minimally invasive mini thoracotomy on a beating heart. The main benefits of this approach are to avoid the sternotomy and decrease the amount of postoperative blood loss.
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