Оцінка результатів пластики мітрального клапана залежно від хірургічного доступу

The aim of the work: to study the impact of surgical approaches on immediate and long-term outcomes of reconstructive interventions on the mitral valve, as well as to assess their effectiveness, safety, and functional results. Materials and Methods. An analysis of the results of mitral valve repair was performed on 134 patients with isolated mitral valve pathology who underwent surgery from 2020 to 2024. The main group included 59 patients after right-sided minithoracotomy, while the comparison group included 75 patients after median sternotomy. The leading diagnostic method for assessing the anatomical and hemodynamic features of the heart was echocardiography. Results. The study included 134 patients with isolated MC pathology who underwent plastic correction of MC in 2020–2024 at the State Institution “Amosov National Scientific Center оf Cardiovascular Surgery and Hereditary Pathology of the National Academy of Medical Sciences of Ukraine” (Kyiv). Hospital mortality was 0 %. Compared with sternotomy, right mini-thoracotomy was associated with increased operative time, cardiopulmonary bypass, and aortic cross-clamping (p<0.05), but was accompanied by less intraoperative blood loss – (196.8±9.8) ml versus (273.1±9.4) ml, p<0.001. In the mini-thoracotomy group, a significant reduction in the duration of postoperative analgesia, stay in the intensive care unit, and hospitalization was observed (p<0.001). The frequency of surgical, non-surgical, and late complications did not differ statistically between the groups, and the efficacy of mitral valve repair exceeded 98 % in both groups. The mean follow-up period was (3±0.8) years (range 6 months to 5 years). During this period, reversible remodeling of the heart chambers, improvement in left and right ventricular systolic function, reduction in pulmonary artery pressure, and absence of repeated mitral valve interventions were noted. The obtained results are consistent with the data in current literature and indicate that right-sided minithoracotomy is a safe and effective alternative to median sternotomy, providing comparable clinical outcomes with a better early postoperative course. Conclusions. Despite the longer duration of the operation and myocardial ischemia time, minithoracotomy provides results of mitral valve repair comparable to traditional sternotomy, is associated with less blood loss, less need for postoperative pain relief, and can be considered a safe and effective minimally invasive surgical approach in selected patients.