Mitral Valve Surgery Via Right Anterolateral Thoracotomy Versus Classic Median Sternotomy

SUMMARY and CONCLUSIONAlthough both right anterolateral thoracotomy and median sternotomy have been used for mitral valve surgery (repair/replacement), the latter approach is considered standard for primary mitral valve surgery. We have tried to prove that primary mitral valve surgery, if performed through right anterolateral thoracotomy, would not only be better accepted cosmetically by patients but also make redo surgery through a median sternotomy easy and trouble free from re-entry bleeding.The aim of this study was to evaluate the efficiency and safety of right anterolateral thoracotomy in comparison with standard median sternotomy in mitral valve surgery.In our study 50 patients with isolated mitral valve disease requiring mitral valve surgery were randomized in two groups:Group A: patients undergoing mitral valve surgery via right anterolateral thoracotomy.Group B: patients undergoing mitral valve surgery via standard median sternotomy.There was no significant difference regarding age, sex, body mass index, NYHA functional class, type of pathology of the valve, preoperative echocardiographic findings including ejection fraction and left atrial diameter.The length of the skin incision was significantly less in the thoracotomy group. Although, the time required for cannulation was significantly higher in the thoracotomy group than in the median sternotomy group but the total operation time in the thoracotomy group was significantly less compared to the median sternotomy group as the time of haemostasis and closure was significantly less in the thoracotomy group. On the other hand the cross clamp time and the total bypass time were almost the same in both groups.Regarding the intensive care unit, the time of mechanical ventilation was significantly lesser in the thoracotomy group but the total I.C.U stay was of no significant difference between the two groups. The amount of blood loss and blood transfusion were significantly lower in the thoracotomy group.On the first day, the pain score was significantly less in midline sternotomy group compared to the right anterolateral thoracotomy group but there was no significant difference of pain score in the second and pre-discharge days between the two groups.The post-operative complications were minimal in both groups and the total hospital stay was the same in both groups.Conclusion:The right anterolateral thoracotomy appears to be a safe alternative approach to median sternotomy for mitral valve surgery, as it provides excellent exposure of the mitral valve and has been proved to be a safe efficient technique.It offers an excellent cosmetic appearance especially in young females, as it was nearly not apparent in most cases. It also carries out the advantage of decreasing the blood loss post-operatively thus minimizing blood requirements, reducing the hazard of blood transfusion and decreasing patient’s costs. It has the advantage of less hours of mechanical ventilation thus decreasing the hazards of prolonged mechanical ventilation. Also mitral valve re-intervention through a median sternotomy is much easier after a previous right thoracotomy especially after complete closure of the pericardium.