Minitoracotomía anterior derecha: un abordaje consolidado

Abstract

IntroductionThe right anterior mini-thoracotomy is an alternative approach to medial sternotomy to treat mitral pathology, tricuspid valve, and atrial septal defect. In addition to avoiding complications associated with sternotomy, this approach provides cosmetic advantages and early recovery. MethodsA retrospective observational study was performed on the entire series of 106 patients operated using a right anterior mini-thoracotomy between January 2013 and June 2019. In the first 55 cases the procedure was performed with direct vision, and from October 2017 the surgery was video-assisted. A comparison is made of the perioperative data of both groups. ResultsThe procedures performed were: 46 mitral repairs, 30 mitral replacements, 15 tricuspid replacements, and 15 atrial septal defect closures. Eighteen patients had previous cardiac surgery. The mean EuroSCORE I was 6.08. Hospital mortality was 0.9% (one patient). Conversion to sternotomy was performed in 6 patients. The mean aortic clamping time and bypass time was 88±27 and 137±36minutes, respectively. The mean hospital stay was 5.8±1.9 days. Only 22% of patients received a red blood cell transfusion. When the perioperative results of the first 55 patients were compared with the group in which video-assisted surgery was performed (51 patients), hospital stay and red blood cell transfusion improved significantly in the video-assisted group. ConclusionsThe right anterior mini-thoracotomy is a safe alternative to sternotomy with at least the same standards of quality and postoperative morbidity and mortality. The introduction of a thoracoscopic camera and experience, improved the initial results.