Minimally Mitral Approach The Way Ahead
Rajneesh Malhotra, Tania Mehta, Chintan Mehta, Pawan Kumar Singh, Ratna Malika Kumar, Ravi Kumar Singh, kewal Krishan.
Max Superspeciality Hospital, Saket, NewDelhi, NewDelhi, India.
Mitral valve disease is a tremendous burden in developing countries like India. Conventional midsternotomy approach to the mitral valve has been a traditionally well accepted. Lately the minimally invasive approach to the mitral valve through right minithoracotomy is evolving as the standard of care for the mitral access as safe and effective way with minimum surgical trauma and multiple additional advantages.
Randomised prospective observational study in 90 patients with mitral valve stenosis undergoing MVR from December 2013 to December 2016 meeting the inclusion criteria of age between 18 to 75 years of age and undergoing isolated mitral valve procedure. The study population divided into two groups based on approach –group 1 MICS v/s group 2 conventional midsternotomy. Primary endpoints studied were mortality , hospital stay and blood products usage and secondary endpoints being risk factors for mortality and morbidity
The primary endpoint of mortality between MICS v/s conventional approach was not significantly different statistically (2.22% v/s 6.67%,p=0.616). The amount of mean blood product usage between the two groups was not significantly different between the two groups (394.7ml in MICS v/s 460.4ml in conventional, p=0.60). the mean hospital stay in the mics groups were 6.1 days and in conventional group is 8.2 days which is statistically significantly different.(p=0.04). statistically significantly difference were observed in the total bypass time (145.4 in mics v/s 97.4 in conventional, p=0.00009), cross clamp time (102.1 in mics v/s 71.8 in conventional, p=0.000003), and early return to work (31.3 in mics v/s 36.6 in conventional ,p=0.000008). no
statistically significant different was found in other risk factors like incidence of AF, stroke rate, ventilation time, reintubation, ejection fraction, mean Pa pressure, pleural effusion, renal dysfunction, reexploration, wound infection, paravalvular leak, pain score, NYHA class readmission and need for reoperation.
Minimally invasive MVR is as safe and as effective means of mitral valve replacement as the standard conventional midsternotomy approach with various advantages over the conventional approach in terms of better cosmesis, shorter hospital stay ,faster return to work and complete avoidance of complications like sternal wound dehiscence.
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