Key result
Right mini-thoracotomy for mitral valve replacement was associated with lower wound infection rates compared to median sternotomy (3.3% vs 20%; p=0.04) and better pain scores.
Why the study?
The advantages of minimally invasive mitral valve surgery over the conventional approach remain debated.
Does right mini-thoracotomy improve postoperative pain, wound satisfaction, and early clinical outcomes compared to median sternotomy in patients undergoing mitral valve replacement?
Cohort (n=60)
Does right mini-thoracotomy improve postoperative pain, wound satisfaction, and early clinical outcomes compared to median sternotomy in patients undergoing mitral valve replacement?
Absolute Event Rate: 3.3% vs 20%
p-value: p=0.04
Right mini-thoracotomy is a safe alternative to median sternotomy for mitral valve replacement, offering improved pain control, better wound satisfaction, and fewer wound infections despite longer operative times.
May reduce infections and pain after mitral valve replacement; hypothesis-generating and requires randomized confirmation.
Background: The advantages of minimally invasive mitral valve surgery over the conventional approach is still debated. This study aimed to evaluate early outcomes after mitral valve replacement (MVR) using the right mini-thoracotomy (RMT) versus median sternotomy (MS). Methods: We prospectively included 60 patients who had MVR from May 2015 to June 2017. We classified patients into two groups; Group A (n= 30) had RMT, and Group B (n= 30) had MS. Postoperative pain score, wound satisfaction, and clinical and echocardiographic outcomes were compared between both groups. Results: The mean age was 39.90 ± 12.34 years in Group A and 45.75 ± 13.10 years in Group B (p= 0.08). Preoperative and echocardiographic data showed no statistical significance difference between the groups. Group A had longer aortic cross-clamp (118.85 ± 40.56 vs. 70.75 ± 24.81 minutes, p<0.001) and cardiopulmonary bypass times (186.70 ± 67.44 vs. 104.65 ± 42.60 minutes, p<0.001). Group B had more blood loss (565 ± 344.3 vs. 241.5 ±89.16 ml/24 hours, p<0.001). The median pain score was 1 (range: 1- 3) in Group A and 4 (2- 8) in Group B (p<0.001), and the median wound satisfaction was 1.5 (1- 4) in Group A and 4 (1- 7) in Group B (p<0.001). Wound infection occurred in 1 (3.3%) patient in Group A and 6 (20%) patients in Group B (p=0.04). Conclusion: Mitral valve replacement through the right mini-thoracotomy could be a safe alternative to median sternotomy. The right mini-thoracotomy was associated with longer operative times but better pain and wound satisfaction scores and lower wound infection.
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Elbadawy et al. (2021) conducted a cohort in Mitral valve replacement (n=60). Right mini-thoracotomy vs. Median sternotomy was evaluated on Wound infection (p=0.04). Right mini-thoracotomy for mitral valve replacement was associated with lower wound infection rates compared to median sternotomy (3.3% vs 20%; p=0.04) and better pain scores.
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