A Sternal Sparing Approach to Mitral Valve Replacement – Comparative Study
Background: A variety of techniques including Mini-sternotomy, right anterior mini-thoracotomy, Port Access approach (Heartport), indirect endoscopic techniques and robotic techniques have been described to reduce incision size in mitral valve surgery. We used a mini-thoracotomy technique (Right Antero Lateral Thoracotomy - RALT) for mitral valve patients and compared our results with the conventional technique (mid sternotomy).
Methods: We randomly allocated 100 consecutive patients presenting to our practice for mitral valve surgery between two groups. The first group (test group) consisted of 50 patients in which mitral valve surgery was performed via mini-right anterolateral thoracotomy (RALT group) approach. The control group (50 patients) underwent classical mitral valve surgery through median sternotomy (MS group). Standard aortic and bicaval cannulation with antegrade blood cardioplegia was adopted in both groups.
Results: The mean age of patients in RALT group was 31.8 ±6.2 years and in MS group was 32.2 ± 7.8 years. The two groups were comparable with respect to age, sex, mitral valve lesion, ejection fraction and NYHA class. The mean CPB time (min) and mean aortic clamp time (min) were significantly less in MS group as compared to RALT group. However, the mean total operative time in RALT and MS group was almost similar. The average blood loss (in ml) via Mediastinal drains was significantly higher in MS group, requiring more blood transfusion as compared to RALT group (p<0.001). The mean extubation time in RALT group was 5.2 ± 0.5 hours and 9.5 ± 2.2 hours in MS group, which was statistically significant in lower in RALT (P<0.001). In MS group, 11 patients (22%) suffered from postoperative complications versus 10 patients (20%) in the RALT group, with no significant difference between the groups. There was no reported mortality in both the group.
Conclusions: The cosmetic appearance in RALT group was excellent, that rivals that of robotically assisted techniques and the patients' wounds were scarcely apparent in the female patients. The study demonstrates the efficacy and safety of this technique, with excellent cosmetic results and no additional cost or risk to the patients.
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