Background: Re-operative mitral valve surgery is sometimes burdened by a greater technical
difficulty and a higher complications rate than the first operation. Minimally invasive
cardiac surgery has become routine, and it could significantly reduce the surgical
risk in redo surgery. The objective of our retrospective observational study is to
assess the results of cardiac reoperations in patients with mitral valve disease approached
trough a 5-7 cm right mini-thoracotomy. Methods: From February 2017 to December 2019,
65 patients underwent re-operative mitral valve surgery in our institution. Cardiopulmonary
bypass (CPB) was started by cannulation of the femoral and jugular vein and femoral
artery or alternatively right axillary artery. Patients enrolled had a mean age of
66.6 +/- 11.5 years. Patients were divided into three groups based on the procedure
adopted: external aortic cross-clamp (EAC), EndoAortic balloon occlusion (EABO) and
ventricular fibrillation (VF). Major complications were evaluated and compared with
a propensity matched population of patients undergoing elective isolated mitral valve
surgery via right minithoracotomy (MVS). Results: The average time between last operation
and reoperation was 7.1 +/- 3.4 years. Fourteen patients (21%) underwent mitral valve
repair and 51 patients (78%) underwent mitral valve replacement; 9 patients (14%)
received tricuspid valve surgery. There was no statistically significant difference
in CPB time between the groups. 7 patients (11%) had a postoperative renal failure,
5 patients (8%) underwent surgical reopening for bleeding; incidence of post-operative
stroke and pace-maker implantation was 3% for both. No deaths were registered during
in-hospital stay and at 30-days echocardiographic control all patients respect the
criterions of device success according with MVARC. Propensity matched patients of
group redo had a longer CPB time (100.8 +/- 42.7 versus 72.8 +/- 16.7 min, P<0.001)
and cross-clamp time (71.9 +/- 30.7 versus 59 +/- 10.7 min, P<0.001) respect to first
operation mitral valve surgery patients. Conclusions: Minimally invasive mitral valve
redo surgery is a safe procedure. Less invasive techniques in redo surgery could minimize
morbidity and mortality without prolonging the duration of CPB.
