Late redo-port access surgery after port access surgery

OBJECTIVES This study presents the first report on short- and long-term outcomes in redo-port access surgery after previous port access surgery (redo-PAS–PAS) for new or recurrent mitral valve (MV) and tricuspid valve (TV) disease. METHODS Our current surgical team performed redo-PAS–PAS in 26 conse...

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Published in:Interactive cardiovascular and thoracic surgery 2016-01, Vol.22 (1), p.13-18
Main Authors: van der Merwe, Johan, Casselman, Filip, Stockman, Bernard, Vermeulen, Yvette, Degrieck, Ivan, Van Praet, Frank
Format: Article
Language:English
Subjects:
Aged
Belgium - epidemiology
Female
Follow-Up Studies
Heart Valve Diseases - mortality
Heart Valve Diseases - surgery
Heart Valve Prosthesis Implantation - methods
Humans
Length of Stay
Male
Mitral Valve - surgery
Reoperation
Survival Rate - trends
Time Factors
Tricuspid Valve - surgery
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Summary:OBJECTIVES This study presents the first report on short- and long-term outcomes in redo-port access surgery after previous port access surgery (redo-PAS–PAS) for new or recurrent mitral valve (MV) and tricuspid valve (TV) disease. METHODS Our current surgical team performed redo-PAS–PAS in 26 consecutive patients who had previous port access surgery (mean age 65.8 ± 13.3 years, 46.2% female, 42.3% older than 70 years, mean logistical EuroSCORE 22.5 ± 21.6%) between 1 February 1997 and 30 June 2014. Surgical indications included among others MV prosthesis dysfunction (n = 8, 30.8%), endocarditis (n = 10, 38.5%) and TV dysfunction (n = 3, 11.5%). The mean time interval between primary PAS and redo-PAS–PAS was 70.32 ± 57.4 months. RESULTS Redo-PAS–PAS procedures included MV replacement (n = 19, 73.1%), MV repair (n = 5, 19.2%), and TV repair (n = 2, 7.7%). Sternotomy conversion was required in 5 patients (19.2%), of which 4 (15.4%) were early conversions due to lung adhesion and 1 (3.8%) due to a late intraoperative complication. The mean cardiopulmonary bypass and cross-clamp times were 163.3 ± 57.9 and 101.2 ± 43.8 min, respectively. Postoperative mechanical ventilation longer than 72 h was required in 4 patients (15.4%). In-hospital morbidities included hospital-acquired pneumonia (n = 3, 11.5%), postoperative air leaks (n = 2, 7.7%) and revision for bleeding (n = 1, 3.8%). The mean length of hospital stay was 16.1 days. Long-term clinical and echocardiographic follow-up were 48.3 ± 39.2 and 44.6 ± 32.9 months, respectively. The Kaplan–Meier analyses for survival and freedom from mitral and tricuspid valve reintervention (n = 26) at 5 years were 83.9 and 95.8%, respectively, with 91.3% of surviving patients classified as being NYHA II or less. Echocardiographic follow-up showed no residual mitral regurgitation more than grade I in all redo mitral valve repairs and no paravalvular leak post-valve replacement. CONCLUSIONS Redo-PAS–PAS is our routine approach and we apply this strategy in the majority of patients who had previous port access surgery. The predicted procedure-related mortality, morbidities, patient satisfaction and long-term outcomes are favourable.
ISSN:1569-9293
1569-9285
DOI:10.1093/icvts/ivv281