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A right thoracotomy approach for mitral and tricuspid valve surgery in patients with previous standard sternotomy: comparison with a re-sternotomy approach

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Abstract

Background

To compare the outcomes of mitral and/or tricuspid valve surgery in patients with previous sternotomy between those who underwent a right thoracotomy and those who underwent re-sternotomy.

Methods

Between October 2009 and May 2015, eighteen patients underwent a right thoracotomy (R group) and 28 underwent re-sternotomy (re-S group). The right thoracotomy was prioritized for previous coronary artery bypass grafting. Follow-up was 100 % complete with a mean follow-up of 1.9 ± 1.5 years for the R group and 2.5 ± 1.4 years for the re-S group (p = 0.2137).

Results

Hypothermic ventricular fibrillation was applied in 33.3 % in the R group and in 7.1 % in the re-S group (p = 0.0424). Hospital mortality, the median intensive care unit stay, and the median postoperative hospital stay were 0 % versus 7.1 % (p = 0.5130), 3 days versus 2 days (p = 0.2370), and 28 days versus 29.5 days (p = 0.8043) for the R group versus the re-S group, respectively. Although the rate of major complications was comparable (R group 33.3 % versus re-S group 25.0 %, p = 0.5401), those contents were not equal. Deep sternum infection developed only in the re-S group (3.6 %) and reoperation for bleeding was required only in the R group (11.1 %). No significant difference was observed in the 2-year cardiac-related mortality-free rate (R group 93.3 ± 6.4 % versus re-S group 90.8 ± 6.4 %, p = 0.7516).

Conclusions

Given study limitations, the right thoracotomy approach after previous sternotomy provided favorable outcomes as well as re-sternotomy. When selecting a right thoracotomy for re-do mitral and/or tricuspid surgery, the surgical strategy needs to be thoroughly planned.

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Acknowledgments

We express special thanks to Dr. Shogo Yokose for collecting patients’ data.

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan

    Takashi Miura, Kazuyoshi Tanigawa, Seiji Matsukuma, Ichiro Matsumaru, Kazuki Hisatomi & Kiyoyuki Eishi

  2. Department of Cardiovascular Surgery, Sasebo General Hospital, Nagasaki, Japan

    Shiro Hazama

  3. Department of Cardiology, Nagasaki University Hospital, Nagasaki, Japan

    Akira Tsuneto

Authors
  1. Takashi Miura
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  2. Kazuyoshi Tanigawa
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Correspondence to Takashi Miura.

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Miura, T., Tanigawa, K., Matsukuma, S. et al. A right thoracotomy approach for mitral and tricuspid valve surgery in patients with previous standard sternotomy: comparison with a re-sternotomy approach. Gen Thorac Cardiovasc Surg 64, 315–324 (2016). https://doi.org/10.1007/s11748-016-0638-z

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  • DOI: https://doi.org/10.1007/s11748-016-0638-z

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