Video-assisted cardiac surgery: Preliminary experience in reoperative mitral valve surgery

Objectives: Video-assisted endoscopic techniques had been applied in the surgical correction of patent ductus arteriosus, vascular ring, or coronary artery disease. However, it has been used only recently in the correction of reoperative mitral valve lesions. Design: Video-assisted cardiac operations were performed on four patients who had received surgical interventions on their mitral valves and needed emergent reoperation. Patients: Four patients (3 men and 1 woman) received emergency surgery from September to December 1995 for thrombosis of mechanical mitral prosthesis (2 patients) and severe mitral regurgitation with previously failed mitral valve repair (2 patients). Six previous operations had been performed on these mitral valves. Patient ages ranged from 26.7 to 68.1 years (mean, 47.3 years). Preoperatively, acute pulmonary edema occurred in two patients, cerebral emboli occurred in one patient, and sepsis was found in one patient. Mechanical ventilatory support was used in two patients before operation. Intervention: The operations were performed through right anterior minithoracotomy, guided by video-assisted endoscopic techniques with femoro-femoral extracorporeal circulation. The operative procedures were thrombectomy of mitral prosthesis in two patients, mitral valve repair in one patient, and mitral valve replacement in one patient. Results: The duration of extracorporeal circulation was 166 to 320 min (222 ± 67 min) and the operation time was 4.6 to 6.8 h (6.1 ± 1.0 h). All patients recovered from the operations rapidly with uneventful postoperative courses except 1 patient who had sepsis preoperatively and died 2 months later. Conclusion: Our experience demonstrates that video-assisted cardiac surgery is technically feasible and could be performed in reoperation of the mitral valve.