Mini-thoracotomy versus Full Sternotomy Techniques in Mitral Valve Surgery: Blood Loss, Wound infections, Post-operative Recovery, Morbidity and Mortality Investigation
- Full sternotomy; Right anterior minithoracotomy; Mitral valve surgery; Early outcomes
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Background: Mitral valve surgery is routinely performed through a Median full sternotomy (MFS) with excellent long term outcomes. Minimally invasive mitral (MIMVS) valve surgery is also a surgical approach that improves operative outcomes. In this study we report early post-operative outcomes in minimally invasive mitral valve surgery compared with MFS access with reference to Blood Loss, Wound infections, post-operative Recovery, Morbidity, Mortality and others variables.
Patient and Methods: This study was a prospective data collection from 52 consecutive patients who underwent isolated mitral valve surgery at our institution from November 2017 to October 2019. Population study was divided to two groups, MIMVS (group I n= 26) and MFS (group II n=26). Pre-operative planning were performed so that to obtain similar characteristics. Intra and post-operative data were analysed.
Results: The baselines characteristics were similar in both groups. Of the 26 patients in group I, 23 (88.46%) underwent mitral valve replacement and 3 a mitral valve repair. All the patients in group II underwent mitral valve replacement. There was no difference in term of mortality and morbidity. MIMVS was associated with longer CPB time (mean 161.9 vs 89.8 mins, P =.025) but similar ACC (99 mins vs 64 P=.468) time. MIMVS Patients had likely lower incidence of red blood cells transfusion (12.2% vs 34.7%,), post-operative haemoglobin was similar before transfusion. Haemorrhage complications were more likely in the group II (26.08 vs 7.7%); requiring inotropic support was found to be higher in the group II (54.5 vs 19%). In addition, patients in the MIMVS group had a shorter mechanical ventilation time (1.6 [1-6] vs 3.6 [2-8] hours; P <.01), shorter ICU stay 1.36 [1-6] vs 3.6 [2-8] days, p<.01. Length of hospital stay and chest tube stay were found to be shorter, respectively 6.9 [6-16] vs 7, 7 [7-13] and (1.38 [1-2] days vs 2.64 [2-4], P <.01). Wound infections were not found in both groups.
Conclusion: Although the controversy interest of minimally invasive mitral valve surgery, it may be associated with less blood loss, faster post-operative recovery but increases operation time.
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