Cardiothoracic Surgeon AdventHealth Tampa Tampa, Florida, United States
Disclosure(s):
Eric Wherley, MD: No financial relationships to disclose
Purpose: Minimally invasive approaches to cardiac surgery have excellent outcomes in the primary setting and are increasingly utilized in reoperative (redo) surgery. We aimed to compare the outcomes of patients who underwent redo minimally invasive cardiac surgery via right thoracotomy after prior sternotomy or thoracotomy. Methods: Redo surgeries were identified for all minimally invasive surgeries performed by a single surgeon from 2019 to 2023. Patients who underwent an operation after previous redo surgery were excluded. The primary outcomes include operative mortality and rate of reoperation for bleeding. We identified 231 patients. Outcomes were compared between redo following mini-thoracotomy for cardiac surgery (Mini Group= 91) and redo following median sternotomy (Sternotomy Group= 140). Comparisons evaluated demographics, operative details, and postoperative outcomes. Results: The median age for the 231 patients was 66 (IQR:55-75) and 55% were female; neither factors were significantly different between redo Mini and sternotomy groups. The groups were comparable in most of their preoperative commodities (kidney, liver, and lung diseases), with similar rates of reduced EF < 40, but more patients with advanced heart failure in the Mini group (14%) compared to sternotomy (6.4%, p=0.047). Most patients underwent mitral (55%) or aortic valve (28%) surgeries. Concomitant surgeries performed in 24% of patients. Fibrillatory arrest was more common in the prior sternotomy group (18% vs 5.5%, p< 0.001) due to increased presence of patent arterial coronary bypass grafts. No difference in cardiopulmonary bypass time was noted (Mini=120 min [105-159] vs Sternotomy=130 [98-169], p=0.4), but the Mini group had shorter cross-clamp time (78 min [65-102] vs 100 [77-129] p< 0.001). A single mortality (0.4%) was noted across the entire study group. There were no significant differences in transfusion requirement (38%), ventilation time (4 hours [3-8]) or ICU stay (35 hours [24-67]). A sternotomy first approach was associated with a longer hospital stay (5 [4.0-8.0] vs 4 days [3.0-6.8] p=0.025) and higher readmission rate (12 [8.6%] vs 1 [1.1%], p=0.016) Conclusion: Utilization of a minimally invasive approach in redo cardiac surgery has excellent outcomes after either mini-thoracotomy or sternotomy. A mini first approach demonstrates improved perioperative outcomes, posited to be driven by favorable adhesion profile and lower prevalence of prior coronary bypass operations. Important considerations for the surgeon include lung isolation techniques and myocardial protection.
Identify the source of the funding for this research project: NA
