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International Society For Minimally Invasive Cardiothoracic Surgery

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The Nipple Cut In Mitral Valve Surgery - Impact On Chest Wall Sensitivity And Patient Satisfaction
Andreas Liebold, Yasemin Uyanik, Günter Albrecht, Hagen Gorki.
Ulm University, Ulm, Germany.

Background: Minimal invasive techniques including endoaortic balloon occlusion and 3D videoscopy applied in mitral valve surgery tempt to minimize the surgical access to the absolute necessary. The best cosmetic results are achieved with a semilunar periareolar incision - the nipple cut. Whether this approach could interfere with patients’ breast sensitivity, their daily activities and sexual behavior was investigated in this study. Methods: A total of 71 patients were subject to mitral valve repair through the nipple cut, 54 of those could be recruited for a follow-up examination. Scars were photographed and measured. The patients’ subjective physical, psychological and sexual perception was evaluated with a questionnaire. To quantify the sensitivity of the thoracic wall a neurological test battery was applied including brush test, tuning fork test, pinwheel test, and testing for heat and cold. Results: All of the 54 patients had a successful mitral valve repair without MR recurrence after a mean follow-up of 15 ± 7 months. The group included 46 males and 8 females. Their median age was 60 (29 - 85) years. Physical appearance varied with a BMI ranging between 19 to 36 kg/m2 (mean BMI 26 kg/m2). Cosmetic results were excellent with only minor keloid formation in 2 patients. Mean scar length was 7.2 ± 1.6 cm. In 7 patients a discrete intercostal herniation was noted, two of them suffering clinical symptoms. In the questionnaire, 21/54 patients (39%) subjectively felt minor disturbance of chest wall sensitivity. However, 52/54 patients (96%) stated no restrictions in daily life activities and 53/54 patients (98%) no changes in sexual behavior. The vast majority of the patients (92%) were completely satisfied with their cosmetic result and almost all of them (98%) would recommend the method to friends and relatives. In none of the patients neurophysiological examination revealed any pathological finding. Conclusion: The periareolar access (nipple cut) in minimally invasive mitral valve surgery is not only a safe way to achieve durable repair results. It has also an important impact on patient’s quality of life and satisfaction. In our opinion, the excellent cosmetic results outweigh possible sensible irritations, which in most patients are not altering daily life or sexual activities.


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