Right-sided minithoracotomy versus upper partial ministernotomy in mitral valve replacement

Background The mitral valve has been traditionally approached through a median sternotomy. However, significant advances in surgical optics, instrumentation, and perfusion technology have allowed for mitral valve surgery to be performed using progressively smaller incisions including the minithoracotomy. Objective To highlight the historical background, surgical anatomy, surgical approaches, and indication of surgery in mitral valve replacement and to compare perioperative morbidity and mortality outcomes in patients undergoing first-time elective mitral valve surgery via upper partial ministernotomy versus right-sided minithoracotomy. Patients and methods This study was conducted on 60 patients who had isolated mitral valve disease or mitral valve disease and tricuspid valve disease. All the patients completed the study, and there was no mortality among the patients. The patients were classified into two groups: group I included 30 patients who had mitral valve replacement with or without tricuspid valve repair through right anterior minithoracotomy (4-7 cm via the right fourth intercostal space) and peripheral cannulation via femoral vessels, and group II included 30 patients who had mitral valve replacement with or without tricuspid valve repair through upper partial ministernotomy and central cannulation for standard cardiopulmonary bypass. Results There was a significant difference in the intensive care parameters. The mechanical ventilation time was shorter in group I, and the blood loss and the blood transfusion required was lesser in group I. The ICU stay was shorter in group I. There was highly significantly less postoperative pain in group I than in group II. Total hospital stay was less in group I than in group II. Regarding the complications, there was no statistically significant difference between both groups. Data for right anterior minithoracotomy mitral valve surgery demonstrate reduced blood loss, fewer transfusions, less pain, faster recovery, and more cosmetic esthetics compared with upper partial ministernotomy. Conclusion We can conclude from previous studies for both groups of patients that minimal invasive approach is feasible for mitral valve surgery without affecting the core of surgery or compromising the surgical target with some advantages and disadvantages and some limitations.