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ISMICS 2025 Annual Meeting
28 - 31 May, 2025 | Istanbul, Turkey
D79
A Case Of Redo Mitral Valve Replacement Via Right Minithoracotomy With Copd And Chronic Pleural Effusion
Part of Topic
Valve – Surgical Valves
A Case Of Redo Mitral Valve Replacement Via Right Minithoracotomy With COPD And Chronic Pleural Effusion.
•79-year-old man with prior MVR (Epic 29 mm), TAP, Maze, and LAA closure in 2020(fullsternotomy).
•Presented with dyspnea; echo showed severe MSR due to bioprosthetic SVD.
•Comorbidities: COPD (on home O₂), chronic pleural effusion, CKD (G3b).
•Due to high resternotomy risk, redo MVR was performed via right minithoracotomy.
•Echo showed severe MSR due to bioprosthetic valve degeneration.
•CT revealed left pleural effusion and bilateral emphysematous changes.
•Pulmonary function test indicated COPD-related respiratory depression (FEV₁: 1.42 L, FEV₁%: 67%).
•3D endoscopic MICS was performed via 3 ports with 1 windows.
•CPB established via femoral artery(+ axilla a) and femoral vein.
•Operation time: 379 min (CPB: 264 min, ACC: 155 min).
•Dissection of adhesion was time-consuming but completed without transfusion.
•CPB was initiated before chest entry due to poor lung function.
•Axillary cannulation helped maintain SpO₂.
•Blunt dissection avoided annular injury during valve explantation.
•CPB weaning followed thorough hemostasis.
•Bilateral ventilation was temporarily resumed if SpO₂ dropped.
•Body temperature was lowered to 31℃ to prevent reexpansion pulmonary edema.
•If poor oxygenation, VV ECMO could be started.
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•These steps ensured safe, minimally invasive surgery.
•The postoperative course was uneventful.
•Extubated 17 hours after surgery and transferred to the ward on POD1.
•Echo showed good prosthetic valve function with no leakage.
•Discharged home on POD14, ambulatory and independent.
•Right minithoracotomy avoided resternotomy and reduced respiratory burden.
•MICS was feasible even with poor pulmonary function.
•Careful planning enabled safe CPB weaning without prolonged one-lung ventilation.
•This case supports the value of MICS in high-risk redo patients.
•A patient with COPD and chronic pleural effusion and poor respiratory function underwent redo mitral valve replacement via a right minithoracotomy with good results.