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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 2007 October;20(5):225-7
Mitral valve surgery by limited right thoracotomy: is the aortic cannulation a safety procedure?
Pomerantzeff P. M. A., Vieira Guedes M. A., De Almeida Brandão C. M., Groppo Stolf N. A.
Heart Institute University of São Paulo Medical School São Paulo, SP, Brazil
Aim. Limited right thoracotomy is an alternative technique for surgical approach of mitral valve. In these cases, femoral-femoral bypass still has been used, rising occurrence of complications related to femoral cannulation. The aim of this study was to describe the technique and results of mitral valve treatment by limited right thoracotomy using aortic cannulation for cardiac pulmonary bypass (CPB).
Methods. Between 1983 and 2004, 93 patients underwent mitral valve surgical treatment in the Heart Institute of São Paulo, with average age of 35 13 years and 89(95.7%) were female. Limited right thoracotomy approach associated with aortic cannulation was used for CPB. Seventy eight (83.9%) patients had rheumatic disease and 81(87.1%) patients presented congestive heart failure NYHA III or IV.
Results. Were performed 44(47.3%) comissurotomies, 34(36.6%) valve repairs, 6(6.45%) mitral valve replacements, 6(6.45%) recomissurotomies and 3(3.2%) prosthetic valve replacements. Conservative surgery was performed in 84 (90.3%) patients. The average CPB and clamp time were 57 28 min and 39 19 min, respectively. There were no in-hospital death, reoperation due to bleeding or conversion to sternotomy. Actuarial survival was 98.1 1.9% in 120 months.
Conclusion. Right thoracotomy associated with aortic cannulation in mitral valve surgery is a simple technique, reproducible and safe. Furthermore, complications related to femoral cannulation were avoided.