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| Video-assisted thoracoscopic redo mitral valve replacement under hypothermic fibrillatory arrest in patients with previous sternotomy |
| WANG Shuwei, CUI Yong, ZHOU Bing, MEI Fuyang, LIU Zhifang, HU Zhibin |
Department of Cardiovascular Surgery, Zhejiang Provincial People’s Hospital, Hangzhou 310014, China
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| Cite this article: |
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WANG Shuwei,CUI Yong,ZHOU Bing, et al. Video-assisted thoracoscopic redo mitral valve replacement under hypothermic fibrillatory arrest in patients with previous sternotomy[J]. JOURNAL OF WEZHOU MEDICAL UNIVERSITY, 2022, 52(2): 98-103.
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Abstract Objective: To summarize the experience in minimally invasive redoing mitral valve replacement with hypothermic fibrillatory arrest technique in patients with a previous cardiac procedure performed through a sternotomy. Methods: The clinical data of 35 patients who underwent video-assisted thoracoscopic mitral valve replacement after previous cardiac surgery (PCS) from October 2017 to December 2019 in Zhejiang Provincial People’s Hospital were retrospectively analyzed. 78 patients who underwent video-assisted thoracoscopic mitral valve replacement (first cardiac surgery, FCS) at the same time were assigned to the control group. All the 113 patients were followed up for 6 months, and their perioperative data and follow-up results were compared between the two groups. Results: There was no significant difference between the two groups in terms of gender, age, tricuspid valve disease, atrial fibrillation, and other major preoperative clinical indicators. The operation time and cardiopulmonary bypass time were longer in the PCS group compared with FCS group [(226.5±11.4) min vs. (189.6±17.7)min, (148.1±16.3)min vs. (105.3±15.3)min, both P<0.01]. There was no significant difference between the two groups in 24-hour post-operative drain volume and perioperative blood transfusion rate [(205.8±27.8)mL vs. (195.3±26.3)mL, 17.1%(6/35) vs. 21.8%(17/78), both P>0.05]. There was no significant difference in postoperative peak cardiac troponin I and blood lactate [(3.0±1.1)μg/L vs. (2.5±1.3)μg/L, (3.0±0.9)mmol/L vs. (2.7±0.8)mmol/L, both P>0.05]. No serious neurological or respiratory complications occurred in all patients postoperatively. At 6-month postoperative follow-up, there was no cardiac death or rehospitalizations for heart failure in either group, and there was no significant difference in cardiac function classification or left ventricular ejection fraction between the two groups (both P>0.05). Conclusion: It is safe and feasible to redo mitral valve replacement using video-assisted thoracoscopy with hypothermic fibrillatory arrest technique in patients with a previous cardiac procedure. In addition to providing good intraoperative exposure, the technique can significantly simplify the operation and obtain satisfactory short-term follow-up results.
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