Minimally invasive redo mitral valve surgery without aortic crossclamp

Introduction: Reoperations of the mitral valve have a higher rate of complications when compared with the first surgery. With the field of video-assisted techniques for the first surgery of mitral valve became routine, reoperation cases began to arouse interest for this less invasive procedures. Objective: To assess the results and the technical difficulties in 10 patients undergoing minimally invasive redo mitral valve surgery. Method: Cardiopulmonary bypass was installed through a cannula placed in the femoral vessels and right internal jugular vein, conducted in 28 degrees of temperature in ventricular fibrillation. A right lateral thoracotomy with 5 to 6 cm in the third or fourth intercostal space was done, pericardium was displaced only at the point of atriotomy. The aorta was not clamped. Results: Ten patients with mean age of 56.9 +/- 10.5 years, four were in atrial fibrilation rhythm and six in sinusal. Average time between first operation and reoperations was 11 +/- 3.43 years. The mean EuroSCORE group was 8.3 +/- 1.82. The mean ventricular fibrillation and cardiopulmonary bypass was respectively 70.9 +/- 17.66 min and 109.4 +/- 25.37 min. The average length of stay was 7.6 +/- 1.5 days. There were no deaths in this series. Conclusion: Mitral valve reoperation can be performed through less invasive techniques with good immediate results, low morbidity and mortality. However, this type of surgery re-quires a longer duration of cardiopulmonary bypass, especially in cases where the patient already has prosthesis. The presence of a minimal aortic insufficiency also makes this procedure technically more challenging.