Right Anterolateral Thoracotomy versus Median Sternotomy in Tricuspid Valve Surgery

Background: The tricuspid valve remains the least studied of the four cardiac valves, and there is still no consensus on the optimal surgical approach for its repair or replacement.A growing body of evidence favours minimally invasive access routes, which may reduce operative morbidity without compromising the quality of the surgical correction.Aim: To compare the early postoperative outcomes of isolated tricuspid valve surgery performed through a median sternotomy versus a right anterolateral thoracotomy.Patients and Methods: This prospective, randomised clinical trial enrolled 40 patients undergoing isolated tricuspid valve repair or replacement at Kasr Al-Aini Hospital between July 2020 and August 2022.Patients were allocated equally to a median sternotomy group (Group 1, n = 20) and a right anterolateral thoracotomy group (Group 2, n = 20).Results: Operative time was significantly shorter in the thoracotomy group than in the sternotomy group (232.15 ± 21.68 vs 294.85 ± 16.82 min; p = 0.001), a difference of approximately 63 minutes (21% reduction).Postoperative drainage was significantly lower in the thoracotomy group (632.5 ± 399 vs 1023.5 ± 439 mL; p = 0.001), a reduction of about 391 mL (38%).Hospital stay was significantly shorter after thoracotomy (6.05 ± 0.99 vs 7.50 ± 2.31 days; p = 0.016).Severe postoperative pain (Visual Analog Scale 7-10) occurred in 2 patients (5%) in the thoracotomy group versus 8 patients (20%) in the sternotomy group (p < 0.05).Total wound infection rate was also significantly lower with thoracotomy (2 patients, 5%) than with sternotomy (6 patients, 15%; p < 0.05), although re-exploration for bleeding (5% vs 15%), inhospital mortality (5% vs 10%), bypass time, and cross-clamp time did not differ significantly between groups (p > 0.05 for all).Conclusion: Right anterolateral thoracotomy is a safe and effective alternative to median sternotomy for isolated tricuspid valve surgery, offering shorter operative time, reduced postoperative drainage, less severe pain, fewer wound infections, and a shorter hospital stay.This approach may be particularly advantageous in patients with a prior sternotomy.