Surgical correction of mitral valve defect of rheumatic etiology from right-sided mini-thoracotomy: experience of one center

Introduction. Rheumatic mitral valve disease remains a common cause of acquired mitral valve disease. Median sternotomy is traditionally considered the "gold standard" surgical approach; however, it is associated with high morbidity and a lengthy recovery period. The development of minimally invasive techniques, particularly right anterior mini-thoracotomy, offers new opportunities for improving treatment outcomes; however, the evidence base for the use of this approach in patients with rheumatic diseases remains insufficient.

The purpose of the study. To compare the immediate results of surgical correction of rheumatic mitral valve defects using right anterior mini-thoracotomy and median sternotomy.

Materials and methods of research. Between 2021 and 2024, 12 surgical interventions for acquired rheumatic mitral valve defects were performed in the Cardiac Surgery Department of Sechenov University Clinical Hospital no 1. Patients were divided into two groups based on surgical approach: Group 1 (n = 6) consisted of patients operated on through a right anterior mini-thoracotomy; Group 2 (n = 6) consisted of patients operated on through a median sternotomy. Intraoperative parameters (operative duration, cardiopulmonary bypass time, aortic cross-clamping time, and blood loss volume), postoperative parameters (duration of mechanical ventilation, intensive care unit stay, mobilization time, postoperative hospital stay, and pain severity), and complication rates were analyzed.

Results. In the mini-thoracotomy group, there was a significantly lower volume of intraoperative blood loss (391,7 ml versus 590 ml; p = 0,004), shorter duration of mechanical ventilation (6 hours versus 12 hours; p < 0,05), shorter time of stay in the intensive care unit (20 hours versus 43 hours; p < 0,05), earlier time of mobilization (2 days versus 4 days; p < 0,05) and shorter duration of pain syndrome (2 days versus 5 days; p < 0,05). The postoperative hospital stay was also significantly shorter with the mini-access (18,0 versus 30,4 days; p = 0,008). The duration of the operation and the time of artificial circulation did not differ significantly between the groups (p > 0,05). There was a tendency towards an increase in the time of aortic cross-clamping with mini-thoracotomy (p = 0,067). The incidence of postoperative complications (mortality, resternotomy, hydrothorax, atrial fibrillation, infectious complications) was comparable in both groups (p > 0,05). The need for blood transfusions was significantly lower in the mini-access group (p < 0,05).

Conclusion. Right anterior mini-thoracotomy for the correction of isolated rheumatic mitral valve defects demonstrates safety and efficacy comparable to median sternotomy. This method offers the advantages of minimally invasive surgery: less blood loss, shorter duration of mechanical ventilation and intensive care unit stay, earlier patient mobilization, and shorter postoperative hospital stay.

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