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Mini-thoracotomy For Mitral Valve Repair: Cosmetics Or Less Invasive?
Marco Diena, Bogdan Adrian Popa, Gheorghe Cerin, Eugenio Novelli, Angelo Romano, Levan Karazanishvili, Gabriele Musica.
San Gaudenzio Clinic, Novara, Italy.

OBJECTIVE: Mini-thoracotomy carries a cosmetic advantage compared to sternotomy but is not clearly proved its clinical benefit in term of a real less invasiveness. This analysis compared two groups of patients affected by degenerative mitral regurgitation (MR) in which the surgical repair was performed through median sternotomy (Group 1) or right mini-thoracotomy (Group 2).
METHODS: Data from 555 patients who underwent MV surgery from January'09 to December'13 were prospectively collected and analysed. For patient's characteristics see table 1. Within the minimally invasive approach the cardiopulmonary bypass was achieved through a percutaneous venous cannula in the groin and a direct ascending aorta cannulation. A flexible aortic cross clamp was applied through the skin incision and cardioplegic arrest was obtained with delivery of antegrade Custodiol® HTK solution. Surgical strategy aimed to correct the MR with a single orifice in both groups according to Carpentier rules except for the treatment of AML prolapse in which we used PTFE neochordae sutures. PML prolapse was corrected by either quadrangular or triangular resection. Statistical analysis: in order to control the effect of possible confounding variables, we have used the model of multivariate regression with age, gender, LVEF and the surgical approach as regressors.
RESULTS: The main results are listed in table 1.

GroupNr.Male (%)AgeLV EFEScoreEC timeACC timePeriop bleeding(ml)ICU stay(d)Transfusion (%)Mech.ventilat.(h)
1(S)373196(52.7)65.7 ±1456.5±105,997'65'5203,1196(52,5)22,8
2(M)182126(69.1)55.7 ±1261.6±63,1110'77'2802,334(18,7)19,4
Table 1. Patients' characteristics and results Follow-up was completed in 95% of patients.At mean 2,2 years of follow-up there were fewer late deaths (0,5 vs 1,3%), reoperation rates (1 vs 1,4%), infective endocarditis(0,5 vs 0,7%) and stroke (0 vs 0,2%) in the mini-thoracotomy group.
CONCLUSIONS: In our experience minithoracotomy has proved several clinical advantages over sternotomy: significative less bleeding and transfusions, shorter ICU stay, less wound infections. Minithoracotomy is a less invasive procedure with similar mid term results.
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