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surgery and MVS. We concluded that the beating heart method was a safe alternative to conventional surgery in redo operations in high-risk groups in particular w15x. Re-operation via the right thoracotomy has become popular because of the difficulties stated above concerning re-operations. We preferred thoracotomy in patients requiring re-operative sternotomy as the right anterolateral thora-cotomy required minimal dissection and mitral valve could be exposed almost perfectly. Re-operative sternotomy poses various risks, such as cardiac injury, embolism, graft injury, sternal dehiscence, phrenic nerve injury, and excessive bleeding. There are also other advantages of thoracot-omy over resternotomy, since the course of the operation is faster with fewer events and it results in less bleeding in the postoperative period requiring less transfusion. Consequently , thoracotomy is a far less complicated operation for the surgeon, and is more easily tolerated by the patients. Of the 29 patients requiring re-operation in the present study, nine underwent the right anterolateral thoracotomy. The beating-heart left thoracotomy approach is a possible choice for patients undergoing operation two or more times. Suzuki et al. reported that they operated 16 redo cases successfully with beating-heart left thoracotomy w16x. Although the technique used in beating-heart MVS is rather simple, it yields low mortality and morbidity rates, indicating the applicability of the technique. Compared with the conventional method, it has shorter operative times, postoperative intubation time and length of hospital stay. Furthermore, less drainage volume and less blood transfusion was observed in this group. Consequently, the postoperative quality of life is improved. One of the weak point of our study is some level of heterogeneity of the groups variables. DM, HT at control group and chronic obstructive pulmonary disease (COPD), active endocarditis at study group are more common. During study period patients were selected randomly for the groups but as a result some variables were aggregated for one of the group. Besides, mitral valve repair procedure are more common in the study group. Because we believe that beating heart valve surgery creates an advantage for the valve repair procedure w17x. We conclude that beating-heart MVS can be performed successfully in selected high-risk patients in particular which will lead to increased morbidity and mortality in the postoperative period. So that this procedure is a choice taken into consideration especially in high-risk patients. References w1x Kaplon RJ, Pham SM, Salerno TA. Beating-heart valvular surgery: a possible alternative for patients with severely compromised ventricular function. …

Right thoracotomy for redo mitral valve surgery with perfused heart on ventricular fibrillation