MINIMALLY IINVASIVE (LIMITED ANTERIOR THORACOTOMY) VERSUS CONVENTIONAL APPROACH (MEDIAN STERNOTOMY) FOR MITRAL VALVE SURGERY PROSPECTIIVE STUDY

Abstract

The mitral valve has been traditionally approached through a median sternotomy. However, significant advances in surgical optics, instrumentation, tissue tele manipulation, and perfusion technology have allowed for mitral valve surgery to be performed using progressively smaller incisions including the minithoracotomy. This study describes the effects of minimally invasive mitral valve surgery approach through right anterolateral minithoracotomy on morbidity and mortality compared with conventional mitral surgery. This study was conducted on 60 patients; all patients had isolated mitral valve disease. All the patients completed the study and there was no mortality among the patients. The patients were classified into 2 groups: • Group I (control group) 30 patients had mitral valve replacement through median sternotomy and central cannulation for standard cardiopulmonary bypass. • Group II (study group) 30 patients had mitral valve replacement through right anterior small thoracotomy (6 – 12 cm via the right 4th intercostal space) and peripheral cannulation via femoral vessels. There was no statistically significant difference as regards the age, sex, NYHA. Preoperative echocardiographic findings also reported no statistical difference. Regarding intraoperative comparison, there was statistically significant difference in the cross-clamp time, total bypass time & total operation time. This difference may be due to the new experiences in this MIMVS and the lack of instrumentation that narrow the field of MIMVS. The length of the incision was highly significantly lesser in group “II” than in group “I”. There was significant difference in the intensive care parameters. The mechanical ventilation time was shorter in group “II”, the blood loss and the blood transfusion required was lesser in group “II”. The ICU stay was shorter in group “II”. There was highly significantly less postoperative pain in group (II) than in group (I). Total hospital stay was less in group (II) than in group (I). As regard the complications there was no statistical significance difference between both groups. Data for minimally invasive mitral valve surgery demonstrate reduced blood loss, fewer transfusions, less pain and faster recovery and more cosmotic compared to conventional sternotomy. Minimally invasive mitral valve surgery is a safe alternative to a conventional approach and is associated with less morbidity especially with expert surgeon in simple mitral valve surgery.