초록접수 현황
| 16F-105 | 구연 발표 |
The Effectiveness of Thoracotomy Approach for Multiple Time Reoperations Involving Mitral Valve
Jae Suk Yoo, Hyoung Woo Chang, Dong Jin Kim, Kwang Ree Cho
Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Gyeonggi-do, Korea
Background : To evaluate the efficacy of right thoracotomy approach for multiple time (third-time or more) reoperations involving the mitral valve.
Methods : Between January 2015 and May 2016, we performed right thoracotomy for multiple time redo mitral valve surgery on 11 patients; third-time in 5 patients, fourth-time in 4 patients, and fifth-time in 2 patients. All patients had undergone previous valve surgeries only through sternotomy approach. Previsouly implanted prosthetic aortic valves existed in two patients. Transthoracic aortic crossclamping with root cardioplegia (HTK solution in 45% and Del Nido solution in 55%) was used in all subjects. An additional incision (extension to upper sternum) was required in one patient to control the ascending aorta.
Results : Mean cardiopulmonary bypass and aortic crossclamping times were 231.7±51.8 and 138.1±47.0 minutes. No intraoperative events such as great vessel injury or lung laceration occurred. There were no postoperative bleeding reoperation, low cardioac output syndrome, pneumonia, or wound problem. One operative mortality occurred in a patient with preoperative septic shock for a prosthetic valve endocarditis. One permanent stroke occurred in a fourth-time redo case. Concomitant procedures including tricuspid annuloplasty in 3, tricuspid valve replacement in 2, and maze in 1 were performed.
Conclusion : Our experience illustrates the effectiveness of right thoracotomy approach to treat mitral pathology while avoiding reoperative sternotomy risk. We found aortic crossclamping and cardioplegic arrest methods to be safe myocardial preservation strategies with this approach.
Methods : Between January 2015 and May 2016, we performed right thoracotomy for multiple time redo mitral valve surgery on 11 patients; third-time in 5 patients, fourth-time in 4 patients, and fifth-time in 2 patients. All patients had undergone previous valve surgeries only through sternotomy approach. Previsouly implanted prosthetic aortic valves existed in two patients. Transthoracic aortic crossclamping with root cardioplegia (HTK solution in 45% and Del Nido solution in 55%) was used in all subjects. An additional incision (extension to upper sternum) was required in one patient to control the ascending aorta.
Results : Mean cardiopulmonary bypass and aortic crossclamping times were 231.7±51.8 and 138.1±47.0 minutes. No intraoperative events such as great vessel injury or lung laceration occurred. There were no postoperative bleeding reoperation, low cardioac output syndrome, pneumonia, or wound problem. One operative mortality occurred in a patient with preoperative septic shock for a prosthetic valve endocarditis. One permanent stroke occurred in a fourth-time redo case. Concomitant procedures including tricuspid annuloplasty in 3, tricuspid valve replacement in 2, and maze in 1 were performed.
Conclusion : Our experience illustrates the effectiveness of right thoracotomy approach to treat mitral pathology while avoiding reoperative sternotomy risk. We found aortic crossclamping and cardioplegic arrest methods to be safe myocardial preservation strategies with this approach.
책임저자: Jae Suk Yoo
Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Gyeonggi-do, Korea
발표자: Jae Suk Yoo, E-mail : mdyoo77@gmail.com