Is The Minimally Invasive Mitral Valve Surgery Superior To The Sternotomy Approach

[Objective] We compare the efficiency, the safety and the patients’recovery of mitral valve surgery via either the minimally invasive right anterior small thoracotomy or the standard sternotomy.[Method]70consecutive adult patients with solo mitral valve lesion were prospectively randomized to undergo minimally invasive (minimally invasive group) or standard (standard group) mitral valve surgery. In the minimally invasive group, we accessed the cardiopulmonary bypass (CPB) by the cannulation of the right femoral vessels. A right anterior4-6cm thoracotomy was made at the fourth intercostal space, and with the help of the thoracoscope, the aorta was occluded by the Chitwood clamp and the mitral valve was exposed and operated after entering the left atrium by the incision of the interatrial groove. In the standard group, we accomplished the surgery by the classic sternotomy. All the operations were finished by a same group of surgeons.[Result] The major preoperative data from both groups were comparable. There was no death in both groups. The transesophageal echocardiography during the surgery demonstrated no more than mild residual mitral regurgitation among all the patients who underwent mitral valve repair. The minimally invasive approach only slightly increased the CPB and cross-clamp time (84.2±22.8min vs78.8±17.5min,46.5±13.4min vs45.8±14.4min, P>0.05) but significantly decreased the length of both mechanical ventilation and ICU stay (6.5±4.3h vs10.6±6.3h,16.2±25.5h vs27.6±16.3h, P<0.05). Besides, the total drainage, as well as the24-hour one, was less in the minimally invasive group (total:758.5±360.6ml vs1223.6±481.0ml,24h:301.8±185.2ml vs566.7±360.8ml, P<0.01). There was comparable risk of the in-hospital morbidities for both groups, except more patients experienced a fever above38.3centigrade for a relatively long period in the standard group (P<0.05). The total cost of both groups were almost at the same level (78649.8±12136.2vs78047.5±14545.6, P>0.05). Although the pain scores were similar between the two groups during the postoperative3months, the patients in the minimally invasive group were more satisfied with their scars (P<0.01). Furthermore, they also had higher scores in both the Karnofsky Performance Scale (KPS) and the self-assessment (P<0.01). Follow-up was performed in all the patients at an average of9.1±2.9months postoperatively. There is no more than moderate mitral regurgitation discovered in the patients who underwent mitral valve repair in both groups, nor is any paravalvular leakage found in those who underwent mitral valve replacement.[Conclusion] Compared with the median sternotomy, the minimally invasive mitral valve surgery demonstrated the same efficiency and safety, with fewer in-hospital days, less drainage and more rapid patients’recovery. The patients experienced no more pain with this small thoracotomy but were more satisfied with their scars.