Early Outcome of Mitral Valve Surgery comparing Minimally Invasive versus Standard Median Sternotomy Approach

Abstract

Background: This study compares our experience of early outcome of mitral valve surgery (MVS) after minimally invasive (MI) versus standard median sternotomy (SMS) approach. Objective: Minimal invasive mitral valve surgery (MIMVS) aims to avoid complications of SMS like; bleeding, postoperative pain, and sternal wound infection. It provides better cosmesis and early recovery. The aim of this study is to evaluate early clinical outcome of MIMVS. Patient and Method: It is prospective comparative cohort study in adult patients with mitral valve disease who perform MVS using either MI or SMS. From January 2020 to December 2021, early outcome of MVS between [120 patients] MI group through right mini-thoracotomy (RMT) with CPB peripheral cannulation and [120 patients] SMS group are compared. Result: Females are more in MIMVS (80%). ACC and CPB time are longer in MIMVS than SMS (118±15.5 vs 74.4±32.3, 155±28.5 vs 115±48.8). Tricuspid repair and left atrial appendage (LAA) occlusion are performed only in SMS. Blood loss is lesser in MIMVS (250 ± 60.6 ml) than in SMS (550 ± 230 ml). Blood transfusion required (0.1 ± 0.53) in MIMVS, and (0.9 ± 0.7) in SMS. Re-exploration for bleeding is required in (4) cases of SMS. Mechanical ventilation time is shorter in MIMVS (6.4 ± 1.3) than in SMS (12.4 ± 6.8). ICU duration and hospital stay are shorter in MIMVS than SMS (2±0.4 vs 3.5±1.3, 7.2±1.3 vs 12±0.5). Wound infections present in (20) cases of SMS. Spirometric studies in MIMVS reveal better postoperative pulmonary functions than SMS group. Pain Visual Analog Score at discharge is better in MIMVS (1.4 ± 0.6) than in SMS (8.5 ± 1.5). There is no hospital mortality in both groups. Conclusion: Minimal invasive mitral valve surgery is a safe procedure and improves cosmesis and patient’s satisfaction.