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Original Articles: Adult Cardiac

Mitral Valve Replacement Through a Minimal Right Vertical Infra-axillary Thoracotomy Versus Standard Median Sternotomy

^a Department of Thoracic Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Peoples Republic of China
^b Department of Cardiovascular Surgery, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences, Beijing, China
^c Heart Center, the First Hospital of Tsinghua University, Beijing, China

Accepted for publication November 24, 2008.

^_* Address correspondence to Dr Li, Department of Thoracic Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008, Peoples Republic of China (Email: lqg0235062{at}163.com).

Background: Minimally invasive valve surgery is becoming a safe and cosmetic alternative to standard median sternotomy (SMS). This retrospective study reviews our results and experience with a right vertical infraaxillary thoracotomy (RVIAT) technique for mitral valve replacement (MVR) compared with SMS.

Methods: Between December, 2003 and February, 2007, 192 patients underwent MVR through RVIAT (group 1). This group was compared with 203 patients who underwent MVR using SMS during the same period (group 2).

Results: Hospital mortality was 1 of 192 (0.5%) patients in group 1 and 1 of 203 (0.5%) patients in group 2 (p > 0.05). There was no late death in either group. The mean length of incision was significantly shorter in group 1 than that in group 2 (8.7 ± 2.2 cm vs 23.5 ± 2.5 cm, p < 0.05). The time to establish cardiopulmonary bypass was longer in group 1 (35.8 ± 7.6 vs 28.3 ± 6.5 minutes, p < 0.05). Group 1 had less chest drainage than group 2 (171 ± 21 vs 336 ± 46 mL, p < 0.05) and required less blood transfusion (159 ± 19 vs 446 ± 16 mL, p < 0.05). Postoperative mechanical ventilation time was also less in group 1 (4.5 ± 1.2 vs 6.5 ± 3.2 hours, p < 0.05). There were no statistical differences in aortic cross-clamp time, cardiopulmonary bypass time, and total operation time between the two groups.

Conclusions: The RVIAT can be performed with favorable cosmetic and clinical results. It provides a good alternative to standard median sternotomy for MVR.