Research Article of American Journal of Surgical Research and Reviews
Mini-thoracotomy versus Full Sternotomy Techniques in Mitral Valve Surgery: Blood Loss, Wound infections, Post-operative Recovery, Morbidity and Mortality Investigation
Issaka Zalle1*, Moussa Son1, Mouhcine El Mardouli1, Mohamed EL-Alaoui1, Macedoine Nijimbere1, Abdoulaziz Thiombiano1, Drissi Boumzebra1
1Cardiovascular Surgery, Mohammed VI University Hospital, Marrakech, Morocco.
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.
Keywords: Full sternotomy; Right anterior minithoracotomy; Mitral valve surgery; Early outcomes
How to cite this article:
Issaka Zalle, Moussa Son, Mouhcine El Mardouli, Mohamed EL-Alaoui, Macedoine Nijimbere, Abdoulaziz Thiombiano, Drissi Boumzebra. Minithoracotomy versus Full Sternotomy Techniques in Mitral Valve Surgery: Blood Loss, Wound infections, Post-operative Recovery, Morbidity and Mortality Investigation. American Journal of Surgical Research and Reviews, 2021; 4:21. DOI:10.28933/ajsrr-2021-04-0806
1. Minoru Tabata, MD; Toshihiro Fukui, MD; Shuichiro Takanashi, MD. Do Minimally Invasive Approaches Improve Outcomes of Heart Valve Surgery? (Circ J 2013; 77: 2232 – 2239).
2. Lillehei CW, Gott VL, Dewall RA, Varco RL. Sur-gical correction of pure mitral insufficiency by an-nuloplasty under direct vision. J Lancet 1957;77(11):446–449.
3. Cohn LH, Adams DH, Couper GS, Bichell DP, Rosborough DM, Sears SP, et al. Minimally inva-sive cardiac valve surgery improves patient sat-isfaction while reducing costs of cardiac valve re-placement and repair. Ann Surg 1997; 226: 421 – 426.
4. Byrne JG, Hsin MK, Adams DH, et al. Minimally invasive direct access heart valve surgery. J Card Surg 2000; 15:21–34.
5. Cohn LH, Adams DH, Couper GS, et al. Minimally invasive cardiac valve surgery improves patients satisfaction while reducing costs of cardiac valve replacement or repair. Ann Surg 1997;226:421– 8.
6. Gammie JS, Bartlett ST, Griffith BP. Small-incision mitral valve repair: safe, durable, and approaching perfection. Ann Surg. 2009; 250:409-15.
7. Greelish JP, Cohn LH, Leacche M, Mitchell M, Karavas A, Fox J, et al. Minimally invasive mitral valve repair suggests earlier operations for mitral valve disease. J Thorac Cardiovasc Surg. 2003;126:365-73.
8. Joerg Seeburger, Michael Andrew Borger, Volkmar Falk, Thomas Kuntze, Markus Czesla. Thomas Walther, et al. Minimal invasive mitral valve repair for mitral regurgitation: results of 1339 consecutive patients. European Journal of Cardio-thoracic Surgery 34 (2008) 760-765.
9. Carpentier A. Cardiac valve surgery – the “French correction.” J Thorac Cardiovasc Surg 1983;86:323– 47.
10. Deloche A, Jebara VA, Relland JYM, et al. Valve repair with Carpentier techniques. The second decade. J Thorac Cardiovasc Surg 1990; 99:990 –1002.
11. Dogan S, Aybek T, Risteski PS, et al. Minimally invasive port access versus conventional mitral valve surgery: prospective randomized study. Ann Thorac Surg 2005; 79:492-8.
12. Plass A, Grunenfelder J, Reuthebuch O, et al. New transverse plate fixation system for complicated sternal wound infection after median sternotomy. Ann Thorac Surg 2007; 83:1210-2.
13. Jian Liu, Bo Chen, Yu-Yuan Zhang, Liang Zheng Fang, Bin Xie, Huan-Lei Huang et al. Mitral valve replacement via minimally invasive totally thora-coscopic surgery versus traditional median ster-notomy: a propensity score matched comparative study. Ann Transl Med 2019; 7(14):341
14. James S, Gammie, MD, Yue Zhao, PhD, Eric D. Peterson, MD, MPH, Sean M. O’Brien, PhD, J. Scott Rankin, MD, et al. Less-Invasive Mitral Valve Operations: Trends and Outcomes From The So-ciety of Thoracic Surgeons Adult Cardiac Surgery Database. (Ann Thorac Surg 2010; 90:1401–10).
15. Giovanni Mariscalco, MD, PhD, and Francesco Musumeci, MD S. Camillo. The Minithoracotomy Approach: A Safe and Effective Alternative for Heart Valve Surgery Department of Heart and Vessels, Cardiac Surgery Unit, Varese Univer- sity Hospital, Varese; and Department of Cardiac Surgery and Transplantation, Hospital, Rome, Italy. (Ann Thorac Surg 2014; 97:356 –64).
16. Glauber M, Miceli A, Gilmanov D, et al. Right an-terior minithoracotomy versus conventional aortic valve replacement: a propensity score analysis. J Thorac Cardiovasc Surg 2013; 145: 1222–6.
17. Ruttman E, Gilhofer TS, Ulmer H, et al. Propensity scorematched analysis of aortic valve replacement by mini-thoracotomy. J Heart Valve Dis 2010; 19:606–14.
This work and its PDF file(s) are licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.