Early clinical outcome after right anterolateral thoracotomy as an alternative for median sternotomy for mitral valve replacement

Abstract

Background: The advantages of the right anterolateral thoracotomy (RALT) approach for mitral valve surgery over standard median sternotomy (MS) are still debatable. The objective of this study was to evaluate and compare the postoperative clinical outcome after RALT and MS for mitral valve replacement.
 Methods: This prospective observational study included 40 patients who underwent mitral valve replacement between January 2016 and August 2018. Patients were assigned to two groups, the first group included 20 patients who had conventional median sternotomy approach and the second group included 20 patients who had right anterolateral thoracotomy with the complete cannulation and aortic cross-clamping conducted through the same incision.
 Results: In comparison to MS, RALT had significantly higher cross-clamp time (77.7±16.1 vs 45.8±8.7 minutes, P < 0.01), total bypass time (105.2±12.7 vs 72.2±10.4 minutes, P < 0.01), and total operative time (287±41 vs 231±36 min, P < 0.01), in addition to significantly lower ventilation time (4.2±1.51 vs 6.1±1.84 hours, P < 0.01), blood loss (229±85 vs 335±137 ml), amount of blood transfusion (1.41±0.6 vs 2.19±1.1 units, P < 0.01), ICU stay duration (2.11±0.49 vs 2.78±0.82 days, P < 0.01), pain scores at 1st and 2nd postoperative days (5.67±0.79 vs 7.81±0.53, p < 0.01), and total hospital stay duration (7.2±1.3 vs 8.4±1.6 days, P = 0.01). Patients' satisfaction about their wound was significantly higher in RALT group compared to MS group (95% vs 30%, P < 0.01).
 Conclusion: The RALT approach for mitral valve surgery could be a safe and effective approach when compared to median sternotomy. RALT could be associated with a reduction of blood loss, blood transfusion, wound infection, in addition to shorter ICU and hospital stay.