Comparative Early and Long Term Results of Mitral Valve Surgery between Right Mini Thoracotomy and Full Sternotomy Approach

Abstract

Background: Conventional mitral valve surgery (MVS) requires median sternotomy. Right mini thoracotomy (RMT) MVS is an alternative non sternotomy approach aiming for less bleeding, pain reduction, rapid recovery, cosmetic satisfaction, safety and effectiveness of the procedure. Objectives: To report early and late clinical results comparing RMT versus full sternotomy (FS) MVS. Materials and Methods: 574 consecutive patients underwent MVS were prospectively non randomized reviewed during January 2002 to October 2018. There were 241 in FS group and 241 in RMT group by age and Euro II score matching. Baseline characteristics were compared. Early and late clinical outcomes of 30 days mortality, reoperation for bleeding, stroke, prolonged ventilation, renal failure, permanent pacemaker, and echocardiographic hemodynamic performance were assessed and compared between two groups. All patient follow-up to December 2020. Results: Similar results were found between RMT and FS MVS groups including age 58.8+13.6, 57.2+14.2, p=0.2, new AF 5 (2%), 4 (1.7%), p=1.0), except for more degenerative valve pathology (79%, 50%, p<0.001). There were more re operation for bleeding 2 (0.8%), 1 (0.3%), p=0.9, less aortic cross clamp time (107+37.3, 115.4+36.4, p=0.017), less cardiopulmonary bypass time (157.6+51.2, 171.3+53.4, p=0.005), less bleeding and blood transfusion requirement in the RMT group. Early clinical results of 30 days mortality, stroke, renal failure, new pacemaker, and hemodynamic performance at one month, three to six month, and one year were comparable in both groups. Mean follow-up (year) was 5.2+2.5 (RMT) and 10.2+4.0 (FS). Survival probability and freedom from MACCE at ten years in RMT and FS group were 94.05%, 95.44% and 99.5%, 90.46%, p<0.001, respectively. Conclusion: RMT approach for MVS is associated with cosmetic satisfaction, less bleeding, similar effective hemodynamic performance and non-inferiority early and late clinical results to FS approach.