A comparative study between L shaped ministernotomy and conventional mitral valve surgery

Objective: It is to determine whether minimally invasive mitral and tricuspid valve surgery through lower ministernotomy improved postoperative outcome when compared to the conventional surgery through total sternotomy. The comparison included: intraoperative time parameters, postoperative complications, intensive care unit and hospital stays, postoperative echocardiography, and in-hospital mortality rate. Patients and methods: Between September 2013 and August 2015 a total number of 41 patients, who underwent mitral and tricuspid valve operations (mitral valve replacement with or without tricuspid valve repair) in Cairo University as well as one of the ministry of health hospitals were included in this study. Of these patients: 19 cases were operated upon via inverted L shaped partial lower sternotomy (Group I) and 22 cases received conventional sternotomy (Group II). Results: There was no statistically significant difference between the two groups in terms of cross clamp time, cardiopulmonary bypass time; however the total procedure time was in favor of the conventional approach. There was a statistically significant difference between the two groups regarding the amount of chest tube drainage, and the need for blood transfusion which was lower in the ministernotomy group. There was a statistically significant difference between the two groups in the ventilation time in favor of the ministernotomy group. The study showed no statistically significant difference in mortality rate between the two groups. Conclusion: Ministernotomy approach for mitral and tricuspid valve surgery is a safe and feasible technique. This technique provides many advantages such as smaller incision with traditional exposure and familiar instruments, decreased amount of postoperative bleeding, need for blood transfusion and decreased duration of ventilation time