Right thoracotomy for mitral reoperation: Analysis of technique and outcome

Background This report describes technical details of the right thoracotomy approach for mitral surgery, and analyzes our experience with this procedu re for patients with a prior sternotomy. Three methods for myocardial manag ement (hypothermic cardioplegic arrest, beating heart, and fibrillating hea rt) are compared. Methods. Records were abstracted of patients who had a right thoracotomy be tween January 1, 1992 and July 1, 1999 for mitral surgery after at least on e prior sternotomy. Demographic, operative, and outcome data were collected for analysis. Telephone follow-up was used to measure postoperative New Yo rk Heart Association functional status., Results. Eighty-four patients (mean age 60 +/- 15 years) had reoperative mi tral surgery via a right thoracotomy. Myocardial management included ventri cular fibrillation in 10 patients, operation on the beating heart in 58 pat ients, and hypothermic blood cardioplegia arrest in 16 patients. The mean t ime in the operating room was 185 +/- 73 minutes, and the mean duration of cardiopulmonary bypass was 63 +/- 56 minutes. There were no perioperative s trokes and the prevalence of death for patients who received cardioplegic a rrest was significantly higher than the prevalence of death for patients wh o had mitral surgery with perfused fibrillating or beating heart techniques (p = 0.007; Fisher's exact test comparing risk-unadjusted mortality). Conclusions. Right thoracotomy provides efficient exposure for reoperative mitral surgery. Mitral valve procedures on the fibrillating or beating hear t are feasible in most patients and are at least as safe as surgery using c ardioplegic arrest. (Ann Thorac Surg 2000;70:1970-3 (C) 2000 by The Society of Thoracic Surgeons.