Redo minimally invasive mitral valve surgery: feasibility, practical benefits, and surgical pitfalls from a single-center experience

To describe surgical outcomes, technical considerations, and feasibility of redo minimally invasive mitral valve surgery using initial cases as a reference cohort. A single-center, retrospective review of minimally invasive mitral valve surgery performed between January 2014 and January 2024 was conducted. Perioperative data, mid-term survival, and cardiac-related events were assessed in both initial and redo groups. A total of 647 patients were included: 30 in the redo group and 617 in the initial group. The redo group had higher European System for Cardiac Operative Risk Evaluation II scores (p < 0.001). In the redo group, 26 (86.7%) had undergone previous cardiac surgery via sternotomy, and 18 (60.0%) had previous mitral valve surgery. The operative time was longer in the redo group (p = 0.041), while the cross-clamping time was longer in the initial group (p = 0.019), and cardiopulmonary bypass time was comparable between groups (p = 0.95). Intubation time (p = 0.049), intensive care unit stay (p = 0.020), and in-hospital stay (p = 0.003) were longer in the redo group. However, there were no significant differences in postoperative chest tube output for 24 h (p = 0.32) or blood transfusion requirements (p = 0.087). The overall survival rates at 5 years were 70.7% (95% CI: 41.0%-87.0%) vs. 92.0% (95% CI: 88.0%-94.0%) for the redo and initial groups, respectively. Freedom from cardiac-related events did not significantly differ between groups. Redo minimally invasive mitral valve surgery was feasible despite higher surgical risk and longer operative times. Early and mid-term cardiac-related outcomes appeared acceptable, although overall survival was lower in redo cases.