Outcomes of Minimally Invasive Approach for Reoperative Cardiac Valve Surgery
Ahmed Alnajar1, Wei Pan, MD2, Jacqueline Olive3, Lauren Gray3, Zachary Gray1, Joseph Lamelas, MD1.
1University of Miami, Miami, FL, USA, 2Texas Heart Institute, Houston, TX, USA, 3Baylor College of Medicine, Houston, TX, USA.
Reoperative cardiac surgery represents a unique surgical challenge with difficult exposure and risk of injury to cardiac structures with subsequent hemorrhage. In comparison to traditional sternotomy-based cardiac surgeries, non-sternotomy minimally invasive approaches minimize tissue trauma and have less risk of cardiac injury and transfusion. We analyzed short-term outcomes to investigate feasibility, safety, and efficacy of the minimally invasive option in reoperative cardiac surgeries.
Between January 2017 and October 2018, 64 patients consecutive (39 males and 25 females) with mean (±SD) age of 62±18 years underwent redo minimally invasive cardiac valve surgery following either previous minimally invasive (n=9) or mid-sternotomy cardiac procedures (n=55) at a single center. These operations comprised of 46 isolated and 18 concominent valve surgeries (table1).
Overall outcomes included rare perioperative complications and adverse events. Mean time to re-operation was 3.34±1.19 years. The median follow-up was 7 (range 2-11) months. The 30-day all-cause mortality was 1.56% (1/64) and operative mortality rate was 3.13% (2/64). Median post-operative length of stay (LOS) was 4 (4-7) days, including an ICU LOS of 24 (24-48) hours and ventilation time 6 (4-11) hours. One patient required a re-intervention to control bleeding. Blood transfusion (red blood cell or frozen plasma) and the first 24 hours chest tube drainage was 1.6±3 units and 411±236 ml respectively.
Reoperative, non-sternotomy-based cardiac surgery can be conducted safely with good overall short-term outcomes. It conserves valuable resources and reduces hospital LOS, ICU LOS, and blood transfusion. Long-term follow-up on current series is warranted.
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