Early post-operative pulmonary function tests after mitral valve replacement: Minimally invasive versus conventional approach. Which is better?

Abstract

BackgroundMinimally invasive mitral valve surgery (MIMVS) is safe, with low perioperative morbidity, and low rates of reoperation. Minimally invasive mitral valve surgery has been proven a feasible alternative to the conventional full sternotomy approach with low perioperative morbidity and short-term mortality. Efforts to minimize surgical trauma, fasten patient recovery, increase patient satisfaction, and reduce cost without compromise to surgical repair or replacement techniques, continue to be the rationale for minimally invasive procedures. In this work, the difference in pulmonary function tests between both approaches was studied among other variables. MethodsIn this study 50 patients with mitral valve disease (MVD) requiring mitral valve surgery were selected by purposive nonprobability sample. The study was done at the Armed Forces Hospitals (mainly Maadi & Galaa Armed Forces Hospitals). 25 patients attended to have mitral valve surgery by right anterolateral mini-thoracotomy (group A) with femoral artery and vein cannulation and other 25 patients by traditional sternotomy (group B). Pulmonary function tests were studied within one week preoperatively and 10 days postoperatively in both groups. ResultsThere was no statistical difference between the two groups preoperatively regarding their age, sex, NYHA class, EF%, LA dimension, and preoperative spirometric study. There was no operative mortality in both groups but fewer postoperative complications occurred in both groups with highly significant differences in favor of minimal invasive group. These included better postoperative pulmonary function tests. There was a highly significant difference in the FVC, FEV1, FVC %, FEV1 % and no significant change in FEV1/FVC between both group denoting better post operative pulmonary function of minimally invasive (group A) patients. There was also less blood loss, less postoperative blood transfusion, less total hospital stay, ICU stay, faster recovery with better cosmetic appearance, and more cost effective. ConclusionMinimally invasive right anterolateral mini-thoracotomy is as safe as median sternotomy for mitral valve surgery, with fewer complications and postoperative pain, less ICU and hospital stay, fast recovery to work with no movement restriction after surgery. There was a highly significant difference denoting better post operative pulmonary function of the minimally invasive approach.