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Research Article
Right anterior mini-thoracotomy in mitral valve surgery: Techniques, patients selection, and early post-operative outcomes
1 Cardiovascular Surgery Department, Mohammed VI University Hospital, Marrakech, Morocco
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Issaka Zallé
Cardiovascular Surgery Department, Mohammed VI University Hospital, Marrakech,
Morocco
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Article ID: 100021C04IZ2021
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Zallé I, Son M, Nijimbere M, El Mardouli M, Boumzebra D. Right anterior mini-thoracotomy in mitral valve surgery: Techniques, patients selection, and early postoperative outcomes. Edorium J Cardiothorac Vasc Surg 2021;8:100021C04IZ2021.ABSTRACT
Aims: In our department, heart valves surgery is performed usually through a full sternotomy. Few years ago we did some experience in minimally invasive valve surgery. That is why we aim to report our experience in minimally invasive mitral valve surgery with reference to patients selection, surgical techniques, and early post-operative outcomes.
Methods: A total of 26 patients undergoing mitral valve surgery for isolated mitral valve disease were analyzed prospectively from November 2017 to October 2019 in our department. All the patients underwent isolated mitral valve surgery.
Results: Our patients were younger, 48.6 [26–66] years, mean weight 56.8 [46–76] kg, sex-ratio at 0.44. The average New York Heart Association was 2.39 [1–3]. They had not heart risks factors. The left ventricular function was good, mean left ventricular ejection fraction (LVEF) was 60.5% [44.5–72], and the mean pulmonary hypertension was 37 [17–89] mmHg. The electrocardiogram showed 38.5% of atrial arrhythmia; the mean pre-operative haemoglobin was 13.6 [11.9–15.7] g/dL. Right anterior mini-thoracotomy with femoro-femoral cardiopulmonary bypass (CPB) was the surgical technique in all the patients. Valve replacement was performed in 84.6% of cases. Three (3) patients underwent mitral valve repair. There were no conversion to full sternotomy and no major complications. The incidence of red blood cells transfusion was 12.2%, mean post-operative hemoglobin at 10.6 [8.1–13.6] g/ dL before transfusion. Heart dysfunction was not found in this study (19% needed inotropic support using and average duration was 1.5 [1–3] hours). The mean CPB time was 161 minutes, aortic cross clamp (ACC) time was 99 minutes. In addition, the mean ventilation time was 3.05 [1–6] hours, length of chest drain stay at 1.38 [1–2] days, mean time of ICU stay at 1.1 [1–6] days, the length of hospital stay 6.9 [6–16] days. Post-operative LVEF was 55.25% [48–68]. There were no chest wound infection, no atrial or ventricular arrhythmia. However, 11.5% of the patients had minor cerebrovascular events and 11.5% had pleural effusion. Moreover, we notified one in-hospital death due to pulmonary failure.
Conclusion: Minimally mitral valve surgery by right anterior mini-thoracotomy can be performed safely without additional operative complications. It may improve early post-operative outcomes. A comparative study with conventional full sternotomy is necessary in order to establish the interest of this new approach.
Keywords: Early outcomes, Full sternotomy, Mitral valve repair, Mitral valve surgery, Right anterior minithoracotomy
SUPPORTING INFORMATION
Author Contributions
Issaka Zallé - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Moussa Son - Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Mouhcine El Mardouli - Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Drissi Boumzebra - Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2021 Issaka Zallé et al.. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
