Minithoracotomy approach for redo mitral valve surgery: Feasibility, operative outcomes, and comparative analysis of myocardial protection techniques

IF 2.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

JTCVS Techniques Pub Date : 2026-10-01 Epub Date: 2026-07-16 DOI:10.1016/j.xjtc.2026.102509

Giovanni Domenico Cresce MD, PhD, Paolo Berretta MD, Manuel Wilbring MD, Jörg Kempfert MD, Torsten Doenst MD, Marc Gerdisch MD, Frank Van Praet MD, Mauro Rinaldi MD, Antonios Pitsis MD, Nikolaos Bonaros MD, Joseph Lamelas MD, Tristan Yan MD, Davide Pacini MD, Antonio Fiore MD, Nguyen Hoang Dinh MD, Pier Luigi Stefano MD, Tom C. Nguyen MD, Loris Salvador MD, Marco Di Eusanio MD

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引用次数: 0

Abstract

Objective

Redo mitral valve surgery (MVS) poses technical challenges and high operative risks as the result of adhesions and sternal re-entry. Right minithoracotomy has emerged as an alternative to repeat sternotomy. This study evaluated feasibility and perioperative outcomes of redo MVS through right minithoracotomy and compared 3 different myocardial protection strategies: cardioplegia, ventricular fibrillation (VF), and beating-heart.

Methods

All patients who underwent redo MVS via right minithoracotomy between 2015 and 2023 were identified from the Mini-Mitral International Registry. The primary end point was in-hospital mortality. Secondary end points included stroke, low cardiac output, bleeding requiring revision, conversion to sternotomy, and major complications. Moreover, 3 myocardial protection strategies were analyzed: cardioplegic arrest (n = 373), VF (n = 105), and beating-heart (n = 24).

Results

A total of 502 patients were included (median age 68 years). Overall in-hospital mortality was 7.6% (4.1% in elective and 24.4% in urgent cases). Conversion to sternotomy occurred in 3%. Stroke rate was 2.8% and reoperation for bleeding was 8.8%. After adjustment, VF was independently associated with a greater risk of low cardiac output (adjusted odds ratio, 3.5; P = .004). Beating-heart surgery was associated with increased in-hospital mortality (adjusted odds ratio, 6.6; P = .02). No significant association was observed between myocardial protection strategy and stroke or major complications.

Conclusions

Redo MVS via right minithoracotomy is feasible and safe in experienced centers. Cardioplegic arrest was associated with more favorable early outcomes and should be considered the default myocardial protection strategy whenever feasible. No-clamp techniques remain valuable in selected high-risk scenarios but are associated with trade-offs that warrant careful patient selection.

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二尖瓣手术微创入路的可行性、手术效果及心肌保护技术的比较分析

目的二尖瓣手术（MVS）由于粘连和胸骨再入，技术难度大，手术风险高。右小胸切开术已成为重复胸骨切开术的替代方法。本研究评估了右小开胸行重做MVS的可行性和围手术期结果，并比较了3种不同的心肌保护策略：心脏骤停、心室颤动（VF）和心脏跳动。方法从mini -二尖瓣国际注册表（mini -二尖瓣国际注册表）中确定2015年至2023年所有经右小切口行二次二尖瓣手术的患者。主要终点为住院死亡率。次要终点包括中风、低心输出量、需要翻修的出血、转向胸骨切开术和主要并发症。此外，还分析了3种心肌保护策略：心脏骤停（n = 373）、VF （n = 105）和心脏跳动（n = 24）。结果共纳入502例患者，中位年龄68岁。总体住院死亡率为7.6%（择期为4.1%，急诊为24.4%）。改用胸骨切开术的发生率为3%。卒中发生率为2.8%，再手术出血发生率为8.8%。调整后，VF与低心输出量的风险增加独立相关（调整后的优势比为3.5;P = 0.004）。心脏搏动手术与住院死亡率增加相关（校正优势比为6.6;P = 0.02）。心肌保护策略与卒中或主要并发症之间无显著关联。结论在经验丰富的中心，经右小开胸行MVS是可行且安全的。心脏骤停与更有利的早期预后相关，应在可行的情况下将其视为默认的心肌保护策略。无钳技术在特定的高风险情况下仍然有价值，但与权衡有关，需要仔细选择患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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