ORIGINAL ARTICLES   

Panminerva Medica 1998 June;40(2):94-7

Copyright © 2000 EDIZIONI MINERVA MEDICA

lingua: Inglese

Right thoracotomy as an alternative for redo mitral valve replacement and concomitant repair of the tricuspid valve

Terada Y., Mitsui T., Sakakibara Y., Tsutsui T., Okamura K., Jikuya T., Atsumi N., Shigeta O.

From the Department of Cardiovascular Surgery Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Japan

Back­ground. We ­report ­the results of a ­right thor­a­cot­o­my for reop­er­a­tion on the ­mitral ­valve ­plus con­com­i­tant pro­ce­dures. ­Access to the aor­ta or to ­repair of oth­er ­lesions by ­this ­approach is con­tro­ver­sial.
Experi­men­tal ­design and set­ting. Ret­ro­spec­tive ­study. Insti­tu­tion­al prac­tice (Uni­ver­sity of Tsu­ku­ba Hos­pi­tal, Tsu­ku­ba, ­Japan).
Meth­ods. ­Until 1995, 9 ­patients under­went ­right thor­a­cot­o­my for ­mitral ­valve reop­er­a­tion. The indi­ca­tion for ­this ­approach was no ret­ro­ster­nal ­space ­with the per­i­car­di­um ­left ­open. Sev­en ­patients had dete­ri­orat­ed bio­pros­the­sis, 1 per­i­pros­thet­ic ­valve leak­age, and 1 re-sten­o­sis. ­Four ­were asso­ciat­ed ­with mod­er­ate tri­cus­pid regur­gi­ta­tion. Oper­a­tions ­were per­formed ­under fib­ril­la­tion. Car­di­o­ple­gia was ­used in 1.
­Results. ­Through thor­a­cot­o­my, 4 under­went ­mitral ­valve re-replace­ment, and 4 ­mitral ­valve re-replace­ment ­plus tri­cus­pid annu­lo­plas­ty. One was aban­doned ­because of ­severe pleu­ral adhe­sion. No neu­ro­log­i­cal inju­ry, or per­i­op­er­a­tive myo­car­dial infarc­tion ­occurred.
Con­clu­sions. The ­right thor­a­cot­o­my was an effec­tive alter­na­tive to ­repeat ster­not­o­my for ­redo ­mitral ­valve oper­a­tion. ­Also, con­com­i­tant ­repair of the tri­cus­pid ­valve ­could be safe­ly ­done by ­this ­approach.