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OBJECTIVE: A right lateral mini-thoracotomy with femoral cannulation for cardiopulmonary bypass is an increasingly used approach for mitral valve surgery (MVS). Outcomes after procedures other than MVS have not been well described.
METHODS:
We retrospectively reviewed 200 cardiac operations via right lateral mini-thoracotomy (MIC) with femoral cannulation between 8/2009 and 11/2011. We investigated the short-term morbidity and mortality with regard to the surgical procedure and 1-year-follow-up data including echocardiography.
RESULTS:
Of the 200 MIC-Patients, 133 had isolated mitral valve operations (114 repairs, 19 replacements). Furthermore, there were 39 combined procedures with additional surgery of the tricuspid valve, 7 patients with an isolated TV-procedure, 8 patients with resection of atrial tumors, 13 cases of closure of atrial septal defects.
Overall in-hospital mortality was 4.5 %. In the individual groups, it was 4.5 % and 5.1 % in the groups of patients with isolated MV-surgery and with combined MV-procedures, and 14.3 % in the isolated TV-group. In patients with resection of tumors or ASD-closures no in-hospital mortality could be observed.
Perioperative morbidity in all patients included new-onset atrial fibrillation (2.0 %), reoperation for bleeding (5.5 %), stroke (4.0 %) and disturbance of wound healing (2.0 %). The overall incidence of minor and major postoperative complications was significantly lower in patients with isolated MVS compared to all other groups. Length of ICU - and hospital-stay were 2.1 ± 2.3 d and 14.0 ± 6.8 d in all 200 patients (Isolated MVS: 1.7 ± 1.5 d, 12.4 ± 4.8 d; other groups: 2.5 ± 2.8 days, 12.69 ± 5.5 d). At follow-up, survival was 94.6 % in total (Isolated MV: 95 %; others: 93.5 %). Freedom from reoperation was 92.8 % (isolated MV: 92.5 %, others: 93.5 %). Mean left ventricular ejection fraction decreased from 61.8 ± 10 % at hospital discharge to 58.9 ± 9.7 % at follow in all patients.
CONCLUSIONS:
Right lateral mini-thoracotomy is a routinely used access for MV-surgery. With our data we could confirm this technique for a wide spectrum of operative procedures that can also be performed with excellent results.