Right Mini-Thoracotomy in the Surgical Treatment of Structural Heart Diseases (SHDs): An Institutional Experience

Year 2023, Volume: 26 Issue: 3, 121 - 127, 21.11.2023

Mustafa Mert Özgür , Halil İbrahim Bulut , Tanıl Özer , Mehmet Aksüt , Anıl Güzeloğlu Mehmet Kaan Kırali

Abstract

Introduction: Surgical treatment of structural heart diseases continues to predominantly involve median sternotomy, despite the ongoing trends favoring minimally invasive approaches that have persisted for many years. In this study, we present data on structural heart disease (SHD) surgeries conducted by our institute using a right mini-thoracotomy approach.

Patients and Methods: This single-center retrospective study included 58 patients who underwent right minithoracotomy procedures between February 2018 and June 1, 2023. Preoperative demographic and medical data were collected from patient files and records. Perioperative and 30-day outcome data were obtained through the national electronic record system.

Results: The average age of the participants was 39.9. Female patients accounted for 31.6% (n= 18) of the participants. The majority of surgeries in this study involved peripheral cannulation and conventional cardioplegia. Mitral valve repair and atrial septal defect closure were the most common procedures performed. Intraoperative outcomes showed favorable results, with no instances of significant bleeding, structural complications, or mortality. Regarding the postoperative 30-day outcomes, the stroke rate was 1.8% (n= 1) among the patients. There were no reported cases of transient ischemic attack (TIA), myocardial infarction (MI), and mortality. The conversion to median sternotomy occurred in 3.4% (n= 2) of the cases. Reoperation and reexploration were required in 1.8% (n= 1) of the cases. The mean length of stay in the ICU was 1.7 days, while the mean length of ward stay was 4.2 days.

Conclusion: This study contributes to the evidence supporting the shift towards minimally invasive approaches in the surgical management of structural heart disease. The low rate of intraoperative conversion, absence of major complications, and favorable postoperative outcomes highlight the safety and feasibility of right mini-thoracotomy. Continued advancements in surgical techniques and clinical expertise are expected to further optimize patient outcomes and improve the quality of care in this field.

Keywords

Thoracotomy, MICS, MVR, mitral repair

References

• 1. Bouhout I, Morgant MC, Bouchard D. Minimally invasive heart valve surgery. Can J Cardiol 2017;33(9):1129-37. https://doi.org/10.1016/j. cjca.2017.05.014
• 2. Van Praet KM, Stamm C, Sündermann SH, Meyer A, Unbehaun A, Montagner M, et al. Minimally invasive surgical mitral valve repair: State of the art review. Interv Cardiol 2018;13(1):14-9. https://doi.org/10.15420/ icr.2017:30:1
• 3. Liava’a M, Kalfa D. Surgical closure of atrial septal defects. J Thorac Dis 2018;10(Suppl 24):S2931-S9. https://doi.org/10.21037/ jtd.2018.07.116
• 4. Wang Q, Xue X, Yang J, Yang Q, Wang P, Wang L, et al. Right minithoracotomy approach reduces hospital stay and transfusion of mitral or tricuspid valve reoperation with non-inferior efficacy: Evidence from propensity-matched study. J Thorac Dis 2018;10(8):4789-800. https://doi. org/10.21037/jtd.2018.07.53
• 5. Glauber M, Miceli A, Canarutto D, Lio A, Murzi M, Gilmanov D, et al. Early and long-term outcomes of minimally invasive mitral valve surgery through right minithoracotomy: A 10-year experience in 1604 patients. J Cardiothorac Surg 2015;10:181. https://doi.org/10.1186/s13019-015- 0390-y
• 6. Nakayama T, Nakamura Y, Kanamori K, Hirano T, Kuroda M, Nishijima S, et al. Early and midterm results of minimally invasive aortic and mitral valve surgery via right mini-thoracotomy. J Card Surg 2020;35(1):35-9. https://doi.org/10.1111/jocs.14313
• 7. Gammie JS, Zhao Y, Peterson ED, O’Brien SM, Rankin JS, Griffith BP. J. Maxwell Chamberlain Memorial Paper for adult cardiac surgery. Less-invasive mitral valve operations: Trends and outcomes from the Society of Thoracic Surgeons Adult Cardiac Surgery Database. Ann Thorac Surg 2010;90(5):1401-8,10. https://doi.org/10.1016/j.athoracsur.2010.05.055
• 8. Semsroth S, Gothe RM, Raith YR, de Brabandere K, Hanspeter E, Kilo J, et al. Comparison of two minimally invasive techniques and median sternotomy in aortic valve replacement. Ann Thorac Surg 2017;104(3):877- 83. https://doi.org/10.1016/j.athoracsur.2017.01.095
• 9. Lamelas J, Nguyen TC. Minimally invasive valve surgery: When less is more. Semin Thorac Cardiovasc Surg 2015;27(1):49-56. https://doi. org/10.1053/j.semtcvs.2015.02.011
• 10. Eqbal AJ, Gupta S, Basha A, Qiu Y, Wu N, Rega F, et al. Minimally invasive mitral valve surgery versus conventional sternotomy mitral valve surgery: A systematic review and meta-analysis of 119 studies. J Card Surg 2022;37(5):1319-27. https://doi.org/10.1111/jocs.16314
• 11. Lei YQ, Liu JF, Xie WP, Hong ZN, Chen Q, Cao H. Anterolateral minithoracotomy versus median sternotomy for the surgical treatment of atrial septal defects: A meta-analysis and systematic review. J Cardiothorac Surg 2021;16(1):266. https://doi.org/10.1186/s13019-021-01648-y