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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.