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Minithoracotomy approach for repair of mitral, tricuspid valves, atrial septal defects and cardiac tumors removal in high risk patients.
Jakub Piotr Staromłyński, Radosław Smoczyński, Anna Witkowska, Wojciech Sarnowski, Jarosław Świstowski, Dominik Drobiński, Paweł Stachurski, Zygmunt Kaliciński, Piotr Suwalski.
Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland.

OBJECTIVE: Minimally invasive surgery is becoming more popular. Due to proven advantages of minimally invasive procedures such as: decreased tissue traumatization, better haemostasis, untouched shoulder girdle, fast recovery. Most described in literature cases involve well selected, low and medium risk patients. It arise a question: if minithoracotomy approach maybe a choice for high risk patients? We analyzed consecutive 64 high risk patients of 235 all-comers were operated via right minithoracotomy.
METHODS: Between November 2011 and December 2015 64 high risk patients of 235 all-comers underwent minimally invasive surgery. Three different groups of high risk patients were selected: patients over 80 years old (20pts), with EF below 35% (15pts) and with EuroScore above 6 (29pts). The surgical access was via right lateral minithoracotomy with the use of CPB via femoral vessels with a jugular vein cannulation in case of right atrial procedure. In one case cannulation was provided through both cervical vessels.
RESULTS: 29 patients underwent repair of the mitral valve, 14 tricuspid valve. Due to lack of possible repair 16 mitral valves were replaced, isolated tricuspid plastic was made in 2 patients and 1 tricuspid valve was replaced, atrial myxoma was removed in 4 patients. We performed 16 ablation and 20 closures of LAA, 1 ASD and 2 PFO. Mean age was 72,12±10,62 years. Preoperative comorbidities included insulin-dependent DM in 29,68% , COPD in 15,625, chronic renal failure in 31,25%, active endocarditis in 6,25%. The mean EF was 41.52±16.91%. The mean EuroScore II was 7,9±6,76 %. Postoperatively, we didn't observe conversion to full sternotomy. During first 24 hours we observed mean drainage- 352.85±298.02 ml. In this particular group of patients blood transfusion rate was low: 2.34±2,08 unit. 30 days mortality we observed in 2 patients (3,1%). In 5 patients we observed postoperative bleeding (2,12%), We did not observe any stroke or neurological incidents. Time of intubation was 8,26 hours. Early appropriate rehabilitation had been implemented.
CONCLUSIONS: Minimally invasive procedures through minithoracotomy are safe and feasible methods in high risk patients. In the most difficult group of patients the most benefits were observed in: early extubation and low rate of transfusion.

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