الفهرس 
HIISTORIICAL BACKGROUNDOnly 14 pages are availabe for public view
 |  | from | 178 |  |  |
| | | from | 178 | | |
Abstract
Although both minimally invasive right anterolateral minithoracotomy and median sternotomy have been used for mitral valve surgery (repair / replacement), the latter approach is still considered the standard approach for mitral valve surgery. We hypothesized that mitral valve surgery, if performed through a right anterolateral minithoracotomy, 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 and less postoperative complication with better pulmonary function.
Objectives
The aim of the study was to evaluate and compare procedure and early postoperative outcome (3 months and 6 months postoperatively) of minimally invasive right anterolateral minithoracotomy versus median sternotomy in mitral valve surgery.
Patients and Methods
Our study was conducted in Armed Forces Hospitals (Maadi Hospital, Kobry Elkoba Hospital & Algalaa Hospital) during (2013-2015) It was a prospective comparative study and after approval of the ethical committee on the study protocol and procedure, sixty patients with Rheumatic mitral valve disease were randomized into two equal groups; group “I” 30 patients underwent mitral valve surgery through standard median sternotomy. group “II” 30 patients underwent mitral valve surgery through a minimally invasive right anterolateral minithoracotomy. The mean age for group “I” was 49.8 ± 11.79 SD (with a range of 29-66 years). The mean age for group II was 43.04 ± 12.62 SD (with a range from 23-61 years). Standard aortic and bicaval cannulation with antegrade aortic root crystalloid cardioplegia was adopted in group“I”, while femoral (venous, arterial) cannulation with antegrade aortic root crystalloid cardioplegia was adopted in group “II”.
Results
There was no statistical difference between the two groups preoperatively regarding their age, sex, NYHA class, EF%, LA dimension,. There was no operative mortality in both groups but fewer postoperative complications such as wound infection; post-operative arrhythmias occurred in both groups. Total hospital stay, ICU stay, postoperative bleeding, inotropic requirement, ventilatory support and blood transfusion were less in group “II” with highly significant statistical difference (P-value < 0.01), with better cosmetic appearance.
Conclusion
Our study proved that the right anterolateral minithoracotomy minimally invasive technique provides more convenient exposure of the mitral valve, even with a small atrium and offers a better cosmetic lateral scar which is less prone to keloid formation. In addition, minimally invasive right anterolateral minithoracotomy for mitral valve surgery was comparable to median sternotomy technique regarding safety, with fewer complications and postoperative pain, less ICU and hospital stay, faster postoperative return to work with no movement restriction after surgery. It should be used as an alternative approach for mitral valve surgery.