Totally thoracoscopic beating-heart redo mitral valve surgery with hyperkalemic bradycardia: technique and early results

Q: What are the key findings of this study?

Totally thoracoscopic beating-heart redo mitral surgery with hyperkalemic bradycardia significantly reduced the incidence of postoperative pneumonia (11.6% vs. 30.9%, OR 3.40) and decreased hospital stay compared to conventional resternotomy.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Redo mitral valve disease (n=111). Intervention: Totally thoracoscopic beating-heart redo mitral surgery with hyperkalemic bradycardia vs. Conventional redo mitral surgery via standard resternotomy. Primary outcome: Incidence of postoperative pneumonia (OR 3.40, 95% CI 1.16-9.98, p=0.02).

Junyi Chen; Zheng Xu; Liangwan Chen; Xiao-Fu Dai

doi:10.21037/jtd-2026-1014

July 1, 2026Journal of Thoracic DiseaseOpen Access

Totally thoracoscopic beating-heart redo mitral valve surgery with hyperkalemic bradycardia: technique and early results

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Key result

Totally thoracoscopic redo mitral surgery is linked to less postoperative pneumonia vs. resternotomy.

OR 3.40
95% CI 1.16-9.98
P=0.02
n=111

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Why the study?

Experience with totally thoracoscopic beating-heart redo mitral valve surgery using systemic hyperkalemic bradycardia remains limited and requires evaluation of early clinical outcomes.

Does totally thoracoscopic beating-heart redo mitral valve surgery with hyperkalemic bradycardia improve perioperative outcomes compared to conventional resternotomy in patients undergoing redo mitral valve surgery?

Key Points

To evaluate the clinical outcomes, safety, and institutional experience of totally thoracoscopic beating-heart redo mitral valve surgery using hyperkalemic bradycardia compared with conventional resternotomy.
Retrospective comparative analysis of 111 patients undergoing redo mitral valve surgery between September 2020 and January 2026.
Compared 43 patients treated with totally thoracoscopic beating-heart surgery via right minithoracotomy (MINI group) using systemic hyperkalemic bradycardia against 68 patients managed with conventional resternotomy (CON group).
Postoperative pneumonia occurred significantly less often in the MINI group than in the conventional group (11.6% vs. 30.9%; OR = 3.40, 95% CI: 1.16–9.98, P=0.02), with zero cases of reoperation for bleeding, ECMO, stroke, or mortality in the MINI group.
Intraoperative blood loss (142.0±67.0 vs. 364.6±153.5 mL, P<0.001), red blood cell transfusions (0.8±1.7 vs. 2.2±1.5 units, P<0.001), and cardiopulmonary bypass duration (104.7±18.7 vs. 121.4±10.0 min, P<0.001) were significantly lower in the MINI group.
Total hospital stay (9.6±2.3 vs. 13.2±2.4 days, P<0.001) and total hospital costs (95,206±6,126 vs. 125,149±14,526 CNY, P<0.001) were significantly reduced in MINI patients.

Study Design

Type

Cohort (n=111)

Multicenter

No

Structured PICO

Does totally thoracoscopic beating-heart redo mitral valve surgery with hyperkalemic bradycardia improve perioperative outcomes compared to conventional resternotomy in patients undergoing redo mitral valve surgery?

P

Population

111 adult patients requiring redo mitral valve surgery, free of aortic valve disease or right-sided chest adhesions, evaluated for early perioperative outcomes after totally thoracoscopic beating-heart surgery versus conventional resternotomy.

I

Intervention

Totally thoracoscopic beating-heart redo mitral valve surgery via right minithoracotomy, employing a systemic hyperkalemic bradycardia technique (potassium chloride titrated to 6-8 mmol/L) during mild hypothermic (35 ℃) cardiopulmonary bypass.

C

Comparator

Conventional redo mitral valve surgery via standard median resternotomy with aortic cross-clamping and myocardial protection using antegrade cardioplegia (HTK or Del Nido solution).

O

Outcome

Early clinical outcomes and perioperative variables (including operative times, blood loss, transfusion requirements, length of stay, hospital costs, and postoperative complications).

Main Result

Odds Ratio: 3.4 (95% CI 1.16–9.98)

Absolute Event Rate: 11.6% vs 30.9%

p-value: p=0.02

Totally thoracoscopic beating-heart redo mitral surgery utilizing hyperkalemic bradycardia is a safe alternative to standard resternotomy, offering reduced operative trauma, fewer blood transfusions, shorter hospital stays, and lower costs.

Limitations

Non-randomized retrospective study design with inherent selection and surgeon bias
Relatively small sample size precluding subgroup analysis or multivariable regression
Single-institution study, potentially limiting generalizability
Lack of long-term follow-up data to assess durability of valve repair or replacement and late survival
No formal assessment of quality of life using validated instruments
Non-randomized retrospective study with inherent selection and surgeon bias
Single institution study performed by experienced surgeons, limiting generalizability
Lack of long-term follow-up to assess durability of valve repair or replacement and late survival
Lack of formal quality of life assessment using validated instruments

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Implication

May support thoracoscopic redo mitral approaches in select centers; leaves open need for randomized confirmation before practice change.

Abstract

Background: Although beating-heart redo mitral valve (MV) surgery has been previously documented in several reports, experience with totally thoracoscopic reoperations remains limited. The present study was undertaken to describe our institutional experience with totally thoracoscopic beating-heart redo MV surgery employing a systemic hyperkalemic bradycardia technique during cardiopulmonary bypass (CPB) and to assess its early clinical outcomes. Methods: A comprehensive retrospective review of the database was undertaken from September 2020 to January 2026. Patients undergoing totally thoracoscopic redo MV surgery via right minithoracotomy (MINI group) were compared with those managed by conventional resternotomy (CON group). Perioperative variables and early clinical outcomes were subjected to comparative statistical analysis. Results: . 30.9%; odds ratio (OR) =3.40, 95% confidence interval (CI): 1.16-9.98, P=0.02]. No cases of reoperation for bleeding, extracorporeal membrane oxygenation (ECMO), stroke, or mortality occurred in the MINI group. Conclusions: Totally thoracoscopic beating-heart redo mitral surgery employing hyperkalemic bradycardia reduces blood transfusion requirements, lowers hospital costs, and shortens length of stay compared with the conventional method. This technique appears safe and effective, and may be appropriately considered for carefully selected patients requiring redo MV surgery.

Discussion

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Cite This Study

Chen et al. (2026) conducted a cohort in Redo mitral valve disease (n=111). Totally thoracoscopic beating-heart redo mitral surgery with hyperkalemic bradycardia vs. Conventional redo mitral surgery via standard resternotomy was evaluated on Incidence of postoperative pneumonia (OR 3.40, 95% CI 1.16-9.98, p=0.02). Totally thoracoscopic beating-heart redo mitral surgery with hyperkalemic bradycardia significantly reduced the incidence of postoperative pneumonia (11.6% vs. 30.9%, OR 3.40) and decreased hospital stay compared to conventional resternotomy.

synapsesocial.com/papers/6ad0fc2515427f6a8403ff58 https://doi.org/10.21037/jtd-2026-1014

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Totally thoracoscopic beating-heart redo mitral valve surgery with hyperkalemic bradycardia: technique and early results

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Totally thoracoscopic beating-heart redo mitral valve surgery with hyperkalemic bradycardia: technique and early results

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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