Key result
Right mini-thoracotomy reoperative MVR linked to ~38-minute shorter operative times vs median sternotomy.
Why the study?
Does reoperative mitral valve replacement under ventricular fibrillation through right mini-thoracotomy using a 3D videoscope improve operative times and clinical outcomes compared to conventional median sternotomy?
Observational (n=37)
No
Does reoperative mitral valve replacement under ventricular fibrillation through right mini-thoracotomy using a 3D videoscope improve operative times and clinical outcomes compared to conventional median sternotomy?
Reoperative mitral valve replacement under ventricular fibrillation through a right mini-thoracotomy using a 3D videoscope is a safe and effective alternative to conventional median sternotomy, offering shorter operative times and ICU stays.
Answers are grounded in this paper and cite their sources.
May support right mini-thoracotomy for selected reoperative mitral cases; leaves open need for randomized confirmation.
BACKGROUND: Conventional reoperative mitral valve surgery by median sternotomy has several difficulties. We performed mitral valve replacement (MVR) under ventricular fibrillation (VF) through right mini-thoracotomy with three-dimensional videoscope for avoiding the problems. METHODS: Between 2006 and 2011, we performed 257 cases of MVR, in which 125 cases underwent isolated MVR. Ten cases of patients underwent reoperative MVR under VF through thoracotomy with three-dimensional videoscope (Group I), and 27 cases of patients underwent reoperative conventional MVR through median sternotomy (Group II). We retrospectively reviewed the outcomes and compared Group I with Group II. Preoperative left ventricular ejection fraction (LVEF) was significantly lower (50.5 ± 19.8% vs 64.4 ± 12.0%; p = 0.046), and significantly higher Euro SCORE was found in Group I (4.8 ± 2.0 vs 3.8 ± 2.4; p = 0.037). RESULTS: Although Group I required cooling and rewarming time, average operative times was significantly shorter in Group I (262 ± 46 min vs 300 ± 57 min; p = 0.044), and cardiopulmonary bypass times and average VF times in Group I and aortic cross-clamp times in Group II were equivalent. There was no significant difference in the average of postoperative maximum creatine kinase (CK)-MB. In-hospital mortality was 0/10 (0%) and 1/27 (3.7%), and postoperative paravalvular leakage occurred in 0/10 (0%) and 1/27 (3.7%), and stroke occurred in 1/10 (10%) and 1/27 (3.7%) for Groups I and II. Two patients underwent reoperation for bleeding in Group II. Intensive care unit stay in Group I was significantly shorter than in Group II (1.8 ± 0.6 days vs 3.0 ± 1.7 days; p = 0.025). CONCLUSIONS: The higher risk of preoperative background in Group I had no effect on the operation. Mitral valve surgery under VF through right mini-thoracotomy can be an alternative procedure for reoperation after conventional various cardiothoracic surgeries.
No takes yet. Share an insight, caveat, or question.
Hiraoka et al. (2013) conducted an observational in Reoperative mitral valve replacement (n=37). Reoperative MVR under ventricular fibrillation through right mini-thoracotomy using three-dimensional videoscope vs. Conventional reoperative MVR through median sternotomy under cardiac arrest was evaluated on Average operative time (minutes) (p=0.044). Reoperative mitral valve replacement under ventricular fibrillation through right mini-thoracotomy significantly reduced average operative time (262 vs 300 minutes) and intensive care unit stay (1.8 vs 3.0 days) compared to conventional median sternotomy.
Synapse has enriched 10 related papers. Consider them for comparative context: