Right minithoracotomy as safe and effective approach for surgical treatment of mitral valve dysplasia

• Dmitry A. Kondratyev
• Molochkov A.V.
• Martyanova Yu.B.
• Igor I. Chernov
• Tarasov D.G.
• Viktor A. Ivanov
• Evgeny P. Evseev

Abstract

The aim of the study was to evaluate safety and efficacy of right minithoracotomy as an access in surgery of mitral valve dysplasia.

Material and methods. A total of 160 patients who underwent surgery due to mitral valve dysplasia between 2009 and 2016 at several centers have been included. Two surgical approaches (via traditional sternotomy in 80 patients, and via right minithoracotomy in 80 patients) have been compared. All operations were performed with normothermic bypass and "Custodiol" cardioplegia. Results. Operation duration in mini-access group (189.4±42.09 min), aortic occlusion (84.49±26.16 min) and cardiopulmonary bypass time (126.71±35.77 min) was higher than in sternotomy group: 172.00±42.61 min (р=0.004) 75.13±24.99 min (р=0,02), 97.56±33.86 min (p<0.001) respectively. Patients of mini-access group demonstrated shorter stay in intensive care unit after operation (32.31±35.05 h vs 48.45±49.47 h, р<0,001). Further postoperative drainage loss in miniaccess group was significantly less than in sternotomy patients (270.8±228 ml vs 603.6±747.6 ml, р<0.001), blood transfusions as well (2.05±3.84 units vs 0.96±1.68 units, р=0,046). Hospital stay was significantly shorter in mini-approach group too (12.52±6.14 days vs 13.68±4.19 days, р=0.01). No differences were revealed in 30-day postoperation morbidity and mortality in both groups. 

Conclusion. Right minithoracotomy is safe and effective approach in surgery of mitral valve dysplasia. Short-term results of the access are similar with conventional approach, but traumatic impact, blood loss, rehabilitation duration are much less in patients undergone to mini-access and cosmetic effect is apparently better. Despite noted advantages the approach has specific contraindications and requires experienced surgical team.

Keywords:right minithoracotomy, mitral valve, connective tissue dysplasia, minimally invasive surgery

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