Periareolar Approach In Female Patients Undergoing Cardiac Surgery
Carlotta Brega, Eliana Raviola, Maurizio Pin, Fabio Zucchetta, Marco Panzavolta, Simone Calvi, Elisa Mikus, Francesco Tizzano, Alberto Tripodi, Alberto Albertini.
Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy.
BACKGROUND: Periareolar minithoracotomy represents an interesting option in minimally invasive cardiac surgery, in terms of safety and cosmesis. The periareolar access is performed in our center for mitral and tricuspid valve surgery, atrial septal defect closure and for the surgical treatment of obstructive cardiomyopathy and it is our preferred in women. Our aim is to assess the results of periareolar incisions in female patients, in terms of nipple postoperative pain, local sensitivity and eventual alterations in mammography after surgery.
METHODS:Fifty-seven female patients underwent periareolar incision, as minithoracotomy approach, from December 2018 to December 2021. Their mean age was 56 ± 12 years, their BMI was 22.5 ± 4.8; their surgery was elective in 93%, with mean Euroscore II about 2 ± 1.3.
RESULTS: Of 57 patients, 87.7% (50 patients) underwent mitral valve repair, whose 6 with associated procedures; 8.8% (5 patients) underwent mitral valve replacement whose 2 with tricuspid annuloplasty associated and 3.5% (2 patients) had isolated tricuspid surgery. The cardiopulmonary bypass and aortic cross-clamp time were 123.2 ± 30.2 and 101.3 ± minutes respectively. There were no conversions to either full sternotomy or larger thoracotomy approach. There were no in-hospital and follow-up deaths. No strokes or wound infections were observed. 5.3% were reoperated during their hospital stay, through the same incision. Mean follow-up was 16 ± 9 months. Within the investigated follow-up, 100% of the patients were satisfied with the aesthetic result, no remarkable postoperative pain was reported, 2 patients had slight hyposensitivity in the nipple area. About 40% had mammography as prevention screening after surgery and no abnormalities were found.
CONCLUSIONS: Periareolar minithoracotomy is a feasible surgical option in female patients, with excellent healing results and preserving the tissues of the mammary gland. 
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