
Reoperative mitral valve surgery can be performed through a redo sternotomy or right anterolateral thoracotomy Redo sternotomy is preferred if concomitant procedures such as coronary artery bypass grafting and/or aortic valve surgery are required. Right anterolateral thoracotomy is the approach of choice if the patient has undergone multiple previous sternotomies, or presents with patient grafts, or if suspicion of severe mediastinal adhesions. The right thoracotomy approach is relatively contraindicated in the following situations: previous right-sided chest surgery, severe chronic obstructive pulmonary disease, or moderate to severe aortic regurgitation.
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