Right mini-thoracotomy versus median sternotomy for mitral valve replacement

Mohamed A. EL-badawy; Mhmoud A. Elshafey; Mostfa M. Abdelraof; Mona Sobhy Emara; Ahmed Sobhy Emara

doi:10.35810/ects.v3i2.178

Mohamed A. EL-badawy Department of Cardiothoracic Surgery, National Heart Institute, Cairo, Egypt
Mhmoud A. Elshafey Department of Cardiothoracic Surgery, Faculty of Medicine, Banha University, Banha, Egypt
Mostfa M. Abdelraof Department of Cardiothoracic Surgery, Elsheikh Zayed Specialized Hospital, Giza, Egypt
Mona Sobhy Emara Department of Anesthesia, Faculty of Medicine, Benha University, Benha, Egypt
Ahmed Sobhy Emara Department of Cardiothoracic surgery, Faculty of medicine, Benha University, Benha, Egypt

DOI: https://doi.org/10.35810/ects.v3i2.178

Keywords: Mitral valve replacement, Right mini-thoracotomy, Median sternotomy, Minimally invasive

Abstract

Background: The advantages of minimally invasive mitral valve surgery over the conventional approach is still debated. This study aimed to evaluate early outcomes after mitral valve replacement (MVR) using the right mini-thoracotomy (RMT) versus median sternotomy (MS).

Methods: We prospectively included 60 patients who had MVR from May 2015 to June 2017. We classified patients into two groups; Group A (n= 30) had RMT, and Group B (n= 30) had MS. Postoperative pain score, wound satisfaction, and clinical and echocardiographic outcomes were compared between both groups.

Results: The mean age was 39.90 ± 12.34 years in Group A and 45.75 ± 13.10 years in Group B (p= 0.08). Preoperative and echocardiographic data showed no statistical significance difference between the groups. Group A had longer aortic cross-clamp (118.85 ± 40.56 vs. 70.75 ± 24.81 minutes, p<0.001) and cardiopulmonary bypass times (186.70 ± 67.44 vs. 104.65 ± 42.60 minutes, p<0.001). Group B had more blood loss (565 ± 344.3 vs. 241.5 ±89.16 ml/24 hours, p<0.001). The median pain score was 1 (range: 1- 3) in Group A and 4 (2- 8) in Group B (p<0.001), and the median wound satisfaction was 1.5 (1- 4) in Group A and 4 (1- 7) in Group B (p<0.001). Wound infection occurred in 1 (3.3%) patient in Group A and 6 (20%) patients in Group B (p=0.04).

Conclusion: Mitral valve replacement through the right mini-thoracotomy could be a safe alternative to median sternotomy. The right mini-thoracotomy was associated with longer operative times but better pain and wound satisfaction scores and lower wound infection.