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OBJECTIVE: Minimally invasive surgery for either mitral or aortic valve surgery through right anterior minithoracotomy (RT) has shown excellent results in terms of mortality, morbidity and hospital stay. However, no study has described the combined minimally invasive mitral and aortic surgery (MIMAS) through RT.
Aim of our study was to report early outcomes in patients undergoing MIMAS through RT.
METHODS: From October 2011 to December 2014, 69 patients underwent MIMAS through RT. Additional procedures were: tricuspid valve repair (n=12) patients, atrial fibrillation surgery (n=8) and miectomy (n=2). A 7-8 cm skin incision was performed through the 2nd or 3rd intercostal space. Cardiopulmonary bypass was achieved by direct ascending aortic cannulation and percutaneous femoral vein drainage into right atrium
RESULTS: No death occurred. Mean age was 66±12, and the median EuroSCORE was 8 (interquartile [IQ] range 4-15). The mean cardiopulmonary bypass and cross clamp time were 135±41 min and 90±32 min respectively. Aortic valve was replaced with either stented (n=21, 30%) or sutureless valves (n= 48, 70%). One patient required a conversion to standard sternotomy. The median ventilation time was 6 hours (IQ range 5-15), as well as the median for intensive care unit and hospital stay was 1 day (IQ range 1-1) and 6 (IQ range 5-8). Two patients had a postoperative stroke, and incidence of postoperative atrial fibrillation was 24%.
CONCLUSIONS: Minimally invasive mitral and aortic surgery through RT is associated with excellent early postoperative outcomes.
However, this procedure is possible after gaining experience with RT either for aortic or mitral valve surgery. The use of sutureless valve have dramatically reduced the operative times. More studies are required to validate our data.