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Updated: Sep 18, 2025
08:50
Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
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Mitral Valve Replacement via Minithoracotomy Versus Conventional Median Sternotomy in Rheumatic Mitral Valve Disease:
Hicham Kbiri1, Rachid Seddiki2, Abdellatif Chlouchi3
1Cardiothoracic Anesthesiology, Intensive Care Unit, and Emergency, Avicenna Military Hospital, Marrakech, MAR.
Cureus
|June 23, 2025
Summary
Minimally invasive cardiac surgery (MICS) for rheumatic mitral insufficiency offers reduced complications and shorter recovery compared to conventional sternotomy. Midterm outcomes remain equivalent, supporting MICS as a viable alternative in experienced centers.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Medical Technology
Background:
- Rheumatic mitral insufficiency (RMI) often requires valve replacement.
- Conventional median sternotomy (CMS) is standard, but minimally invasive cardiac surgery (MICS) is an emerging alternative.
- Comparative data for MICS vs. CMS in RMI, especially in resource-limited settings, is scarce.
Purpose of the Study:
- To compare surgical outcomes, early complications, and midterm recovery between MICS and CMS for severe RMI.
- To evaluate the safety and efficacy of MICS as an alternative to CMS in a multicenter setting.
Main Methods:
- A multicenter retrospective study of 55 adult patients with severe RMI undergoing elective mechanical mitral valve replacement (2020-2024).
- Patients were divided into MICS (n=27) and conventional median sternotomy (CMS) (n=28) groups.
- Primary endpoint: 30-day all-cause mortality. Secondary endpoints: operative times, complications, ICU/hospital stay, functional recovery, valve performance, and event-free survival.
Main Results:
- No significant difference in 30-day mortality between MICS (3.7%) and CMS (3.6%).
- MICS showed significantly shorter cardiopulmonary bypass (68.3 vs. 87.5 min) and aortic cross-clamp times (54.7 vs. 77.1 min).
- MICS was associated with reduced pneumonia (0% vs. 10.7%), fewer arrhythmias (7.4% vs. 39.3%), and shorter hospital stay (6.2 vs. 7.3 days).
Conclusions:
- MICS for severe RMI demonstrated fewer early complications and shorter operative/recovery times compared to CMS.
- Midterm outcomes at 12 months, including left ventricular ejection fraction and event-free survival, were comparable between groups.
- MICS is a safe and effective alternative for selected RMI patients in experienced centers.
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