Reoperative mitral valve replacement via right mini-thoracotomy with ventricular fibrillatory arrest for a patient with severely calcified aortic homograft.

We successfully performed reoperative mitral valve replacement (MVR) for a patient with a previous extensive cardiac surgery that included aortic homograft replacement for aortic and mitral valve endocarditis complicated with aortic root abscess. The aortic homograft function was well preserved without aortic insufficiency, although the homograft was highly calcified. We used a right mini-thoracotomy approach and ventricular fibrillatory arrest to avoid an aortic cross-clamping. Only minimal dissection was needed to obtain enough exposure to perform the redo MVR. The reduction in invasiveness helped to prevent major injury during the surgery, shortened the cardiopulmonary bypass and operation time, and facilitated the patient's recovery. Right mini-thoracotomy with ventricular fibrillatory arrest is a viable option for reoperative MVR in patients with previous sternotomy and unclampable aorta.