ANTEROLATERAL MINITHORACOTOMY APPROACH VERSUS MEDIAN STERNOTOMY FOR MITRAL VALVE REPLACEMENT

Abstract

The mitral valve has been traditionally approached through a median sternotomy. However, mitral valve surgery could be performed using 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 30 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) 15 patients had mitral valve replacement through median sternotomy and central cannulation for standard cardiopulmonary bypass. • Group II (study group) 15 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”. But the ICU stay was nearly the same 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).