The Egyptian Cardiothoracic Surgeon

Conventional versus Minimally Invasive Mitral Valve Surgery: A Comparative Analysis of Clinical Outcomes and Patient Recovery

Thu, 01 Jan 2026 00:00:00 +0200

Background: The evolution of surgical techniques has led to increased adoption of minimally invasive mitral valve surgery, yet comprehensive comparative analyses of clinical outcomes remain essential for optimal patient selection and surgical planning. This study compared the clinical outcomes, operative characteristics, and postoperative recovery parameters between conventional and minimally invasive mitral valve surgery.

Methods: This prospective cohort study analyzed 100 patients undergoing mitral valve repair (MVR), with 50 patients in each group (conventional MVR n=50, minimally invasive MVR n=50).

Results: Significant demographic differences were observed between groups, with the conventional group being older (52.32±10.19 vs 42.68±11.95 years, p<0.001) and having lower rates of hypertension (22% vs 42%, p=0.032), chronic kidney disease (14% vs 42%, p=0.002), and smaller left atrial dimensions (4.3 vs 4.65 cm, p<0.001). The minimally invasive group demonstrated significantly longer cardiopulmonary bypass times (100 vs 136 minutes, p<0.001) and ischemic times (64 vs 79 minutes, p<0.001). However, the minimally invasive approach was associated with significantly reduced intensive care unit stay (4 vs 3 days, p<0.001), shorter hospital length of stay (9 vs 8 days, p<0.001), and decreased ventilation time (9 vs 7 hours, p<0.001). However, the conventional approach had markedly improved pain scores, with 2% experiencing severe pain compared to 30% in the minimally invasive group (p<0.001). Postoperative complications showed comparable bleeding rates (10% vs 12%, p=0.749) and wound infections (8% vs 2%, p=0.362), though the minimally invasive group had higher rates of pleural effusion (2% vs 26%, p=0.001).

Conclusions: Minimally invasive mitral valve surgery demonstrates comparable safety profiles to conventional approaches while offering significant advantages in postoperative recovery, including reduced hospital stay and shorter ventilation requirements. However, the technique requires longer operative times and may be associated with specific complications such as pleural effusion. These findings support the continued development and selective application of minimally invasive techniques in mitral valve surgery.

Conventional left atriotomy versus the superior septal approach for mitral valve replacement: a clinical controlled randomized trial

Thu, 01 Jan 2026 00:00:00 +0200

Background: The most effective techniques to enhance mitral valve visualization while reducing risks associated with the procedure are still debatable. Therefore, this study compared the results of conventional left atriotomy (LA) with those of the superior septa (SS) approach for mitral valve replacement (MVR).

Methods: This randomized controlled clinical trial included patients who underwent MVR between 2024 and 2025. The participants were randomly assigned to: Group A (n=27) included patients who underwent MVR through conventional LA, and Group B (n=33) included patients who had a SS incision for MVR.

Results: The mean age in Group A was 43.04±9.02 years, whereas that in Group B was 47.33±9.92 years (P=0.09). There were no differences in sex or smoking status between the groups (P=0.73 and 0.84, respectively). No statistically significant differences were observed in the preoperative clinical, echocardiography or laboratory data. Cardiopulmonary bypass and ischemic times were shorter in patients with the SS approach (87±12 vs. 81±8 min, P=0.048 and 70±10 vs. 65±6 min, P=0.01, respectively). The vasoactive inotropic score was significantly lower in patients in Group A (P=0.04). Mechanical ventilation [9 (7–12) vs. 12 (9–12) h, P=0.02], ICU stay [3 (3–5) vs. 4 (3–5) days, P=0.09] and hospital stay [9 (8–11) vs. 11 (9–12) days, P=0.01] were shorter in patients in Group A. There were no differences in postoperative atrial fibrillation, heart block, superficial wound infection, or re-exploration for bleeding between the groups. No significant difference in changes in the ejection fraction (β: -0.002 (95%CI: -0.03-0.028), P=0.86) left atrial diameter (β: -0.11 (95%CI: -0.29-0.07), P=0.23) end-systolic diameter (β: -0.06 (95%CI: -0.27-0.14), P=0.55) between the groups.

Conclusions: Both LA and the SS approach are viable options for MVR. A SS approach was associated with shorter operative times; however, LA was associated with faster postoperative recovery, with no difference in the complication rate. Further studies with large sample sizes and longer follow-up periods are warranted.

Levosimendan as a rescue therapy for low output syndrome after cardiac sugery

Ahmed Saad, Mohamed Elsayed, Ahmed Abdelaziz , Mohamed Gomaa, Amr Rayan — Thu, 01 Jan 2026 00:00:00 +0200

Background: The calcium sensitizer levosimendan has been shown to improve outcomes in patients with low cardiac output syndrome (LCOS) following cardiac surgery. We assessed its efficacy when used as a rescue therapy in the postoperative setting rather than as a prophylactic preoperative treatment.
Methods: According to our institutional protocol, 18 patients with LCOS that persisted despite conventional inotropic therapy received a 24-hour infusion of levosimendan at 0.1 μg/kg/min. Hemodynamic parameters and clinical outcomes were monitored and statistically analyzed.
Results: Ejection fraction (EF) increased significantly from 29 ± 5% to 41.6 ± 2.7 within 48 hours of initiating levosimendan. This improvement was accompanied by a significant increase in cardiac output from 3.7 ± 0.5 L/min to 5.6 ± 0.8 L/min after 48 hours, along with significant dose reductions in concomitant vasopressors and inotropes. Inotropic support was significantly reduced at the 12-hour assessment compared to the immediate postoperative period and continued to decline over the 48-hour observation window. The norepinephrine dose showed a significant reduction at 48 hours. The overall perioperative mortality was 11%.
Conclusion: Our study suggests that levosimendan is an effective rescue therapy for managing LCOS postoperatively. Its administration should be part of a controlled regimen that avoids unnecessary delays and allows for the concurrent use and monitoring of conventional inotropes.

Right Ventricular Dysfunction Post-Surgical Repair of Fallot Tetralogy in Pediatric Age Group: Predictor Factors Analysis

Thu, 01 Jan 2026 00:00:00 +0200

Background: Right ventricular (RV) dysfunction is often detected after Tetralogy of Fallot (TOF) repair. We aimed to analyze the preoperative, intraoperative, and postoperative risk factors for RV dysfunction and to correlate them to the surgical technique used in the repair.

Methods: This prospective cohort study included 26 pediatric patients with TOF. The participants were divided into two groups based on RV dysfunction. Group A included patients with RV dysfunction, and Group B included patients without RV dysfunction. Each patient was assessed clinically and via echocardiography and cardiac magnetic resonance. Participants were followed for 6 months.

Results: The incidence of RV dysfunction was 30.8% of patients. Compared to group B, patients in group A had significantly low preoperative oxygen saturation (p=0.011), high Right ventricular outflow tract pressure gradient (RVOT PG) (p=0.03), operative transannular patch (p=0.011), prolonged intubation time (p=0.017), and pediatric intensive care unit stay (p=0.001), high incidence of inadequate urine output (p=0.014), prolonged inotropic use (p=0.02) as well as low postoperative tricuspid annular plane systolic excursion (TAPSE) (p˂0.001) and fractional area change (FAC)(p˂0.001), and high RVOT pressure gradient (p˂0.001). However, regression analysis showed no statistical correlation between these variables and RV dysfunction.

Conclusion: Physicians should consider low preoperative oxygen saturation, high RVOT PG, operative transannular patch, long intubation time and pediatric intensive care unit stay, high incidence of inadequate urine output, prolonged inotropic use as well as low postoperative TAPSE and FAC, and high RVOT pressure gradient as risk factors for RV dysfunction after TOF repair in pediatrics.