EP19 INFERIOR REVERSED J SHAPED MINI STERNOTOMY FOR MITRAL VALVE SURGERY

Abstract

Abstract Background and Aim: To reduce the morbidity of mitral valve surgery, we present our mininvasive approach. Methods: From January 2017 to April 2018, 35 patients underwent mitral valve surgery using a partial lower sternotomy through a 9–12 cm longitudinal median skin incision and a left reversed “J-shaped” ministernotomy from the second intercostal space to the xiphoid. Mitral valve replacement was performed in 8 patients (22.8%), while mitral valve repair (using quadrangular resection, sliding plasty or butterfly technique in addition to intertrigonal annuloplasty band) in 27 patients (77.2%). Results: One patient (4.4%) required conversion to full sternotomy. Twenty-four patients (68.5%) were extubated within 6 hours of surgery, and 75% of patients spent less than 24 hours in the intensive care unit (ICU). Mean hospital length of stay was 7.2 +/- 3.4 days. Eighty percent of patients received no blood products. We did not register any operative mortality or re-exploration for bleeding. Morbidity included respiratory insufficiency in 3 patients (6.6%) and wound infection in 1 patients (2.2%). Conclusions: We chose the lower mini-sternotomy because the mitral valve exposure is very similar to that of the full sternotomy and enables repair with the same degree of success as the full sternotomy does. Furthermore, ease conversion to conventional surgery when needed make this technique preferable to the right minithoracothomy approach. The mininvasive approach, in addition to its cosmetic benefits, reduce the sternal trauma, avoid excessive rib traction, reduces the postoperative pain and allows early extubation, mobilization and discharge from the ICU.