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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
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Propensity-matched comparison of right mini-thoracotomy versus median sternotomy for isolated mitral valve repair

Sabet W Hashim1, Sean R McMahon1, Irena K Vaitkeviciute1

  • 1Hartford Health Care Heart and Vascular Institute, Hartford Hospital, Hartford, CT, USA.

The Journal of Cardiovascular Surgery
|September 15, 2022
PubMed
Abstract

Insights

Right mini-thoracotomy (RT) offers reduced morbidity and shorter hospital stays for mitral valve (MV) repair compared to median sternotomy (MS). This approach also lowers costs with similar cross-clamp times and comparable intermediate outcomes.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Minimally Invasive Surgery

Background:

  • Mitral valve (MV) repair via right mini-thoracotomy (RT) is associated with benefits like reduced postoperative morbidity and shorter hospital stays compared to median sternotomy (MS).
  • However, RT has historically shown longer cross-clamp times and higher operative costs.

Purpose of the Study:

  • To evaluate the impact of a modified operative technique on outcomes for isolated myxomatous mitral valve repair using RT versus MS.
  • To compare postoperative morbidity, cross-clamp time, hospital stay, costs, and intermediate outcomes between the two surgical approaches.

Main Methods:

  • A retrospective study comparing 158 patients undergoing RT and 129 patients undergoing MS for myxomatous MV repair (2016-2021).
  • Propensity score matching based on the Society of Thoracic Surgeons Risk Score was used to create comparable cohorts of 108 patients each.
  • Outcomes assessed included ventilation time, atrial fibrillation, hospital length of stay, cross-clamp time, leaflet resection, Gore-Tex NeoChords implantation, major complications, re-operation rates, and total hospital costs.

Main Results:

  • Propensity-matched RT patients demonstrated significantly reduced ventilation time (P=0.025), postoperative atrial fibrillation (P=0.019), and hospital length of stay (P<0.001).
  • Cross-clamp times were similar between RT and MS groups (66.4±13.7 vs 64.8±16.0 minutes, P=0.414).
  • The RT group showed less leaflet resection (32.4% vs 57.4%, P<0.001) and fewer Gore-Tex NeoChords implanted (1.7±0.7 vs 2.1±1.0, P=0.028), with lower direct total hospital costs (P=0.018).
  • No significant differences were observed in 30-day major surgical complications or freedom from re-operation at mean follow-up (98.2% vs 98.2%, P=0.800).

Conclusions:

  • The modified RT approach for myxomatous MV repair is associated with less postoperative morbidity and shorter hospital stays compared to MS.
  • This approach achieves similar cross-clamp times, reduced total hospital costs, and comparable intermediate outcomes.
  • RT presents a viable alternative to MS for myxomatous MV repair, offering improved efficiency and patient recovery.

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