Limited right anterolateral thoracotomy for mitral valve surgery

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Cardiac Surgery
• Thoracic Surgery

Background:

• The Port Access technique for mitral valve surgery, while minimally invasive, presents challenges including high costs and a steep learning curve.
• Conventional mitral valve surgery via median sternotomy results in significant scarring.

Purpose of the Study:

• To evaluate the efficacy and safety of a mini-thoracotomy approach for mitral valve surgery.
• To compare outcomes of mini-thoracotomy versus conventional median sternotomy for mitral valve procedures.

Main Methods:

• A randomized controlled trial involving 100 patients undergoing mitral valve surgery.
• Patients were assigned to either a mini-right anterolateral thoracotomy group (50 patients) or a conventional median sternotomy group (50 patients).
• Standardized aortic and bicaval cannulation with antegrade blood cardioplegia was employed in both groups.

Main Results:

• No significant preoperative differences were observed between the groups.
• The mini-thoracotomy group had a slightly longer mean bypass time (64+/-12 min) but a shorter cross-clamp time (27+/-8 min) compared to the sternotomy group (59+/-11 min bypass, 31+/-9 min cross-clamp).
• Both groups showed no hospital mortality, with one morbidity (sternal infection) in the control group. Mean hospital stay was similar (7+/-2 days).

Conclusions:

• The mini-thoracotomy technique for mitral valve surgery yields excellent cosmetic results, particularly beneficial for female patients.
• This approach is demonstrated to be safe, effective, and cost-neutral, offering a viable alternative to conventional sternotomy.