Totally thoracoscopic beating-heart redo mitral valve surgery with hyperkalemic bradycardia: technique and early results.

BACKGROUND: Although beating-heart redo mitral valve (MV) surgery has been previously documented in several reports, experience with totally thoracoscopic reoperations remains limited. The present study was undertaken to describe our institutional experience with totally thoracoscopic beating-heart redo MV surgery employing a systemic hyperkalemic bradycardia technique during cardiopulmonary bypass (CPB) and to assess its early clinical outcomes. METHODS: A comprehensive retrospective review of the database was undertaken from September 2020 to January 2026. Patients undergoing totally thoracoscopic redo MV surgery via right minithoracotomy (MINI group) were compared with those managed by conventional resternotomy (CON group). Perioperative variables and early clinical outcomes were subjected to comparative statistical analysis. RESULTS: A total of 111 patients were included (43 MINI, 68 CON). The MINI group had shorter CPB time (104.7±18.7 vs. 121.4±10.0 min), total operative time (179.4±37.9 vs. 233.0±25.9 min), and intraoperative blood loss (142.0±67.0 vs. 364.6±153.5 mL), with significantly fewer red blood cell (0.8±1.7 vs. 2.2±1.5 units) and plasma transfusions (7.0±25.8 vs. 97.8±121.7 mL) (all P<0.001). The MINI group also had reduced chest drainage, shorter ventilation time, decreased intensive care unit (ICU) stay and reduced total hospital stay (all P<0.001). Hospital cost was lower in the MINI group [95,206±6,126 vs. 125,149±14,526 Chinese Yuan (CNY), P<0.001]. The incidence of postoperative pneumonia was significantly lower in the MINI group [11.6% vs. 30.9%; odds ratio (OR) =3.40, 95% confidence interval (CI): 1.16-9.98, P=0.02]. No cases of reoperation for bleeding, extracorporeal membrane oxygenation (ECMO), stroke, or mortality occurred in the MINI group. CONCLUSIONS: Totally thoracoscopic beating-heart redo mitral surgery employing hyperkalemic bradycardia reduces blood transfusion requirements, lowers hospital costs, and shortens length of stay compared with the conventional method. This technique appears safe and effective, and may be appropriately considered for carefully selected patients requiring redo MV surgery.