Is a minithoracotomy approach justified for heart valve surgery in high risk patients?

Abstract

We report our experience with a minimal invasive approach for valvular heart disease in patients at high risk. From February 2002 to June 2007, 97 (age 62,5 years) patients underwent heart valve surgery through a right anterolateral minithoracotomy at the fourth intercostal space. 24 of them (24.7%) were classified as at high risk (HR group): redo (58%), euroscore >10 (54%) and associated procedures (cryo-maze ablation, pulmonary lobectomy, coronary artery bypass graft, multiple valve surgery). The remaining patients were considered at lower risk (LR group) and otherwise comparable to the HR group. HTEA was applied to 67% and 50% of the LR and HR group (p 0.06). One patient died for cerebral ischemia (HR group) and one for the detatchment of a mitral prosthese (LR group). A short circulatory arrest was required to repair a posterior aortic lesion in two redo cases. Early extubation was achived in 51% and 66.6% of the LR and HR group respectively. There was no difference between operative time and aortic cross-clamping time (217±45 vs 276±80min and 70±16 vs 64±37min in the LR and HR group) whereas perfusion time was significantly longer in the MR group (p 0.0001) as well as hospital stay (p 0.006). The need of transfusion (12/24) and cerebral events (3/24) rates were higher in the HR group (p 0.03 and 0.006). At a mean follow-up of 28.6±13.9 months the 95 survived patients are alive and well. Right anterolateral minithoracotomy approach is a valuable option for heart valve surgery with acceptable perioperative morbidity and mortality even in high risk patients.