Minithoracotomy approach for repair of mitral, tricuspid valves, atrial septal defects and cardiac tumors removal in 235 consecutive patients.
Jakub Piotr Staromłyński, Radosław Smoczyński, Anna Witkowska, Paweł Stachurski, Jarosław Świstowski, Zygmunt Kaliciński, Wojciech Sarnowski, Dominik Drobiński, Piotr Suwalski.
Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland.
OBJECTIVE: Minimally invasive cardiac surgery is becoming more and more popular. Due to proven advantages of minimally invasive procedures such as: decreased tissue traumatization, which provides better haemostasis and untouched shoulder girdle that enables fast recovery. We analyzed consecutive 235 all-comers who were operated via right minithoracotomy.
METHODS: Between November 2011 and December 2015 we performed right minithoracotomy in 235 consecutive patients. The surgical access was made through right lateral minithoracotomy with use of extracorporeal circulation via femoral vessels. In one case cannulation was provide via cervical vessels. When the tricuspid valve was involved additionally the right internal jugular vein was cannulated.
RESULTS: Mean (SD) age was 63.9±12,8 years; 11 patients underwent previous sternotomy. Mitral valve was replaced in 21 and repaired in 72 patients. Tricuspid valve repair was performed in 11 patients. Tricuspid valve was replaced in 4 patients. Preoperative comorbidities included insulin-dependent diabetes mellitus in 12,7% , COPD in 5,53%, chronic renal failure in 10,63%, active endocarditis in 2,5%. The mean left ventricular Ejection Fraction was 54.78±12.06 %. The mean EuroScore II was 6,9±7,01 %. Three different groups of patients were selected according to the most common "high risk" definitions: patients over 80 years old (20 patients), patients with Ejection Fraction below 35% (15 patients) and patients with EuroScore above 6 points- 29 patients. Median cardiopulmonary bypass was 166.23± 71.7 and cross-clamp times were 87.06 ± 49.5 minutes. We did not observe conversion to full median sternotomy. Reopening for bleeding was necessary in 9 (3,8%) patients. Acute kidney injury was reported in 6 patients (2,55%). 4 patients had neurological complications (1,7%). The average stay in ICU were 2.41± 1.61 days. During first 24 hours we observed mean drainage- 395.25± 332.01 ml. Blood transfusion rate was low: 1.72±2,88. 30 days mortality was 2.97 %. Patients underwent minimally invasive procedures did not have a deep wound infection nor vascular complication.
CONCLUSIONS: Minimally invasive procedures via minithoracotomy are safe and feasible methods in consecutive all-comers. Due to decreased tissue traumatization it provides better haemostasis. Small incision and untouched shoulder girdle enable fast recovery. In the most
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