Reoperative minimal access aortic valve surgery: Minimal mediastinal dissection and minimal injury risk

Minoru Tabata, Zain I Khalpey, Prem S. Shekar, Lawrence H. Cohn

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Objective: Minimizing surgical access in reoperative cardiac surgery allows limitation of dissection, trauma, and manipulation of patent bypass grafts. We report an 11-year experience with reoperative minimal access aortic valve surgery through an upper hemisternotomy. Methods: From July 1996 to June 2007 at our institution, 146 patients underwent reoperative minimal access aortic valve surgery, 109 of whom had undergone previous coronary artery bypass grafting and 93 of whom had a patent left internal thoracic artery graft. In patients with a patent left internal thoracic artery graft, the graft remained undissected. Myocardial protection was achieved with hypothermia, cold cardioplegia, and systemic hyperkalemia. Early and late outcomes were analyzed. Results: Median age was 76 years, and 43 patients (29%) were 80 years or older. Nineteen patients(13%) underwent concomitant procedures, such as coronary artery bypass grafting, mitral valve repair, and ascending aortic replacement. Median cardiopulmonary bypass and aortic crossclamp times were 150 and 80 minutes, respectively. Four patients (2.8%) had conversion to full sternotomy. Operative mortality was 4.1% (6/146). The incidences of reoperation for bleeding and blood transfusion were 0.7% (1/146) and 83.6% (122/146), respectively. No patient had left internal thoracic artery or aortocoronary graft injury. Median stay was 8 days, and 56% (79/140) were discharged home. Five-year actuarial survival was 85%. Conclusion: An upper hemisternotomy approach for reoperative aortic valve surgery is safe and feasible. This approach minimizes tissue dissection and trauma, thereby reducing the risk of injury to patent grafts and mediastinal organs.

Original languageEnglish (US)
Pages (from-to)1564-1568
Number of pages5
JournalJournal of Thoracic and Cardiovascular Surgery
Volume136
Issue number6
DOIs
StatePublished - Dec 2008
Externally publishedYes

Fingerprint

Aortic Valve
Dissection
Transplants
Mammary Arteries
Wounds and Injuries
Coronary Artery Bypass
Induced Heart Arrest
Hyperkalemia
Sternotomy
Hypothermia
Cardiopulmonary Bypass
Mitral Valve
Reoperation
Blood Transfusion
Thoracic Surgery
Hemorrhage
Survival
Mortality
Incidence

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Reoperative minimal access aortic valve surgery : Minimal mediastinal dissection and minimal injury risk. / Tabata, Minoru; Khalpey, Zain I; Shekar, Prem S.; Cohn, Lawrence H.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 136, No. 6, 12.2008, p. 1564-1568.

Research output: Contribution to journalArticle

@article{43dac8bfc87e4690bb4b1338052d3bff,
title = "Reoperative minimal access aortic valve surgery: Minimal mediastinal dissection and minimal injury risk",
abstract = "Objective: Minimizing surgical access in reoperative cardiac surgery allows limitation of dissection, trauma, and manipulation of patent bypass grafts. We report an 11-year experience with reoperative minimal access aortic valve surgery through an upper hemisternotomy. Methods: From July 1996 to June 2007 at our institution, 146 patients underwent reoperative minimal access aortic valve surgery, 109 of whom had undergone previous coronary artery bypass grafting and 93 of whom had a patent left internal thoracic artery graft. In patients with a patent left internal thoracic artery graft, the graft remained undissected. Myocardial protection was achieved with hypothermia, cold cardioplegia, and systemic hyperkalemia. Early and late outcomes were analyzed. Results: Median age was 76 years, and 43 patients (29{\%}) were 80 years or older. Nineteen patients(13{\%}) underwent concomitant procedures, such as coronary artery bypass grafting, mitral valve repair, and ascending aortic replacement. Median cardiopulmonary bypass and aortic crossclamp times were 150 and 80 minutes, respectively. Four patients (2.8{\%}) had conversion to full sternotomy. Operative mortality was 4.1{\%} (6/146). The incidences of reoperation for bleeding and blood transfusion were 0.7{\%} (1/146) and 83.6{\%} (122/146), respectively. No patient had left internal thoracic artery or aortocoronary graft injury. Median stay was 8 days, and 56{\%} (79/140) were discharged home. Five-year actuarial survival was 85{\%}. Conclusion: An upper hemisternotomy approach for reoperative aortic valve surgery is safe and feasible. This approach minimizes tissue dissection and trauma, thereby reducing the risk of injury to patent grafts and mediastinal organs.",
author = "Minoru Tabata and Khalpey, {Zain I} and Shekar, {Prem S.} and Cohn, {Lawrence H.}",
year = "2008",
month = "12",
doi = "10.1016/j.jtcvs.2008.07.043",
language = "English (US)",
volume = "136",
pages = "1564--1568",
journal = "Journal of Thoracic and Cardiovascular Surgery",
issn = "0022-5223",
publisher = "Mosby Inc.",
number = "6",

}

TY - JOUR

T1 - Reoperative minimal access aortic valve surgery

T2 - Minimal mediastinal dissection and minimal injury risk

AU - Tabata, Minoru

AU - Khalpey, Zain I

AU - Shekar, Prem S.

AU - Cohn, Lawrence H.

PY - 2008/12

Y1 - 2008/12

N2 - Objective: Minimizing surgical access in reoperative cardiac surgery allows limitation of dissection, trauma, and manipulation of patent bypass grafts. We report an 11-year experience with reoperative minimal access aortic valve surgery through an upper hemisternotomy. Methods: From July 1996 to June 2007 at our institution, 146 patients underwent reoperative minimal access aortic valve surgery, 109 of whom had undergone previous coronary artery bypass grafting and 93 of whom had a patent left internal thoracic artery graft. In patients with a patent left internal thoracic artery graft, the graft remained undissected. Myocardial protection was achieved with hypothermia, cold cardioplegia, and systemic hyperkalemia. Early and late outcomes were analyzed. Results: Median age was 76 years, and 43 patients (29%) were 80 years or older. Nineteen patients(13%) underwent concomitant procedures, such as coronary artery bypass grafting, mitral valve repair, and ascending aortic replacement. Median cardiopulmonary bypass and aortic crossclamp times were 150 and 80 minutes, respectively. Four patients (2.8%) had conversion to full sternotomy. Operative mortality was 4.1% (6/146). The incidences of reoperation for bleeding and blood transfusion were 0.7% (1/146) and 83.6% (122/146), respectively. No patient had left internal thoracic artery or aortocoronary graft injury. Median stay was 8 days, and 56% (79/140) were discharged home. Five-year actuarial survival was 85%. Conclusion: An upper hemisternotomy approach for reoperative aortic valve surgery is safe and feasible. This approach minimizes tissue dissection and trauma, thereby reducing the risk of injury to patent grafts and mediastinal organs.

AB - Objective: Minimizing surgical access in reoperative cardiac surgery allows limitation of dissection, trauma, and manipulation of patent bypass grafts. We report an 11-year experience with reoperative minimal access aortic valve surgery through an upper hemisternotomy. Methods: From July 1996 to June 2007 at our institution, 146 patients underwent reoperative minimal access aortic valve surgery, 109 of whom had undergone previous coronary artery bypass grafting and 93 of whom had a patent left internal thoracic artery graft. In patients with a patent left internal thoracic artery graft, the graft remained undissected. Myocardial protection was achieved with hypothermia, cold cardioplegia, and systemic hyperkalemia. Early and late outcomes were analyzed. Results: Median age was 76 years, and 43 patients (29%) were 80 years or older. Nineteen patients(13%) underwent concomitant procedures, such as coronary artery bypass grafting, mitral valve repair, and ascending aortic replacement. Median cardiopulmonary bypass and aortic crossclamp times were 150 and 80 minutes, respectively. Four patients (2.8%) had conversion to full sternotomy. Operative mortality was 4.1% (6/146). The incidences of reoperation for bleeding and blood transfusion were 0.7% (1/146) and 83.6% (122/146), respectively. No patient had left internal thoracic artery or aortocoronary graft injury. Median stay was 8 days, and 56% (79/140) were discharged home. Five-year actuarial survival was 85%. Conclusion: An upper hemisternotomy approach for reoperative aortic valve surgery is safe and feasible. This approach minimizes tissue dissection and trauma, thereby reducing the risk of injury to patent grafts and mediastinal organs.

UR - http://www.scopus.com/inward/record.url?scp=57949085682&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=57949085682&partnerID=8YFLogxK

U2 - 10.1016/j.jtcvs.2008.07.043

DO - 10.1016/j.jtcvs.2008.07.043

M3 - Article

C2 - 19114207

AN - SCOPUS:57949085682

VL - 136

SP - 1564

EP - 1568

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

SN - 0022-5223

IS - 6

ER -