MITRAL VALVE REPLACEMENT BY RIGHT ANTEROLATERAL THORACOTOMY VERSUS STANDARD MEDIAN STERNOTOMY
Gamal Abdel-Shafy Ibrahim Farag and Mohammed Seddiq Al-Awadi Ismaiel
Cardiothoracic Surgery Department Faculty of Medicine, Al-Azhar University
Background: In the past, the majority of mitral valve surgery had been performed using conventional full median sternotomy. However, it is associated with bad cosmetic appearance and higher rate of complications. Aim of the study: To compare right anterolateral (RAL) thoracotomy with standard median (SM) sternotomy for mitral valve replacement (MVR) as regard to different variables including cosmetic aspects. Patients and Methods: The study comprised 46 patients with mitral valve disease undergoing MVR. The patients were divided in to two groups; group 1 included 23 patients who underwent MVR via RAL thoracotomy and group 2 including another 23 patients who were subjected to MVR via SM sternotomy for comparison. All patients were examined and evaluated systematically. Both groups were compared for length of incision, surgical exposure, mean cross clamp time, mean bypass time, and mean intensive care unit (ICU) and hospital stay. Sepsis, dehiscence, healing, and cosmetic quality were studied. Results: Both groups were comparable as patients' age, sex, New York Heart Association (NYHA) class and ejection fraction, total bypass time, and total operative time. The incision length, cross clamp time, ICU and total hospital stay were significantly shorter in RAL thoracotomy group. The scar visibility was reported in all patients in SM sternotomy group compared to 30.4% in RAL thoracotomy group. In addition, there was statistically significant increase of scar hypertrophy and stretching in sternotomy group compared to thoracotomy group (39.1%, 26.1% vs. 4.3%, 4.3%, respectively). There was statistically significant increase of patient satisfaction with scar cosmetic appearance in thoracotomy compared to sternotomy group (69.6% vs. 0.0%, respectively). Conclusion: Thoracotomy through a RAL aspect offers a better exposure to the mitral apparatus even in patients with small left atrium, allowing easy mitral valve replacement, which is indicated by the lower cross clamp time. Also, the shorter hospital stay of thoracotomy approach is an additional advantage. Further, it had a satisfactory cosmetic result.
December 2013