Submammary incision as right minithoracotomy approach with intercostal nerve exclusion and blockage technique: A comparative study in the young Indian female population undergoing mitral valve replacement

Objective: This study compares the quality of mitral valve (MV) replacement performed through a submammary right thoracotomy incision with nerve sparing opening and closure to the standard midline sternotomy procedure. Materials and Methods: Hundred young female patients underwent MV replacement with 50 patients in the thoracotomy group and the remaining 50 patients in the median sternotomy group between August 2013 and April 2014 with follow-up till August 2015. Demographics, procedures, operative techniques, and postoperative morbidity and mortality, along with follow-up, were recorded in both the patients and compared. Results: In our study, postoperative pain and postoperative drainage were significantly lower in the thoracotomy variant with 60% of the cases draining only 100-200 mL. Morbidity is quite less in the thoracotomy variant with 60% of the cases able to stand up without support postoperatively 12 h after extubation while the number is only 20% in the sternotomy variant and that too with sternal support. Most of the thoracotomy cases were discharged from the hospital within 1 week. On follow-up, there were only two cases, i.e., 4% of the total cases presenting with hypertrophied scar, which is significantly lower than 20% of the sternotomy cases where three cases developed into keloid while in the sternotomy cases, 10 (20%) cases reported with wound discharge and infection. Conclusions: This procedure provides the same quality of treatment through a less traumatic and better cosmetic incision, resulting in less hospital stay and a lower overall cost.