Minithoracotomy Approach For Repair Of Mitral, Tricuspid Valves And Atrial Tumors Removal In High Risk Patients.
Jakub P. Staromłyński, Radoslaw Smoczynski, Anna Witkowska, Maciej Bartczak, Pawel Stachurski, Wojciech Sarnowski, Dominik Drobinski, Piotr Suwalski.
Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland.
BACKGROUND: Minimally invasive cardiac surgery is becoming more and more popular. Due to proven advantages of minimally invasive procedures such as: decreased tissue traumatization, which provides better haemostasis and untouched shoulder girdle that enables fast recovery. Most described in literature cases involve well selected, low and medium risk patients. We analyzed consecutive 80 high risk patients of 235 all-comers who were operated via right minithoracotomy. METHODS: Between November 2011 and December 2017 80 high risk patients of 235 all-comers underwent minimally invasive surgery for repair of mitral, tricuspid valves, atrial septal defects and atrial tumors removal. Three different groups of high risk patients were selected: patients over 80 years old (25 patients), patients with EF below 35% (20 patients) and patients with EuroScore above 6 (35 patients). The surgical access was via right lateral minithoracotomy with the use of extracorporeal circulation 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: 35 patients underwent minimally invasive mitral repair, 20 tricuspid valve. Due to lack of possible repair 20 mitral valves were replaced, isolated tricuspid repair was made in 3 patients and 1 tricuspid valve was replaced, atrial myxoma was removed in 6 patients. Mean (SD) age was 72,12 ±10,62 years. Preoperative comorbidities included insulin-dependent diabetes mellitus in 29,68% , COPD in 15,625, chronic renal failure in 31,25%, active endocarditis in 6,25%. The particular postoperative data were summared in table. Table 1. 30 days mortality we observed in 3 patients (3,7%). In 5 patients we observed postoperative bleeding (6,2%), In one case was observed ischemic stroke (1,2%). There were no difference in RBC (p=0,5), FFP(p=0,3) and platelets(p=0,8) infusion between the groups. There were no difference in time of total ventilation (p=0,5), stay in ICU (p=0,1) and total drainage (p=0,9). In total group of all-comer patients in Kaplan-Maier curve we observed worse survivability in miniMVR group than miniMVP study. We did not achieved statistical significance (p=0,6). Figure 1. CONCLUSIONS: Minimally invasive procedures via minithoracotomy are safe and feasible methods in consecutive high risk all-comers. Due to decreased tissue traumatization it provides better haemostasis. Small incision and untouched shoulder girdle enable fast recovery. 
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