Initial experience of thoracoscopic video-assisted minimally invasive mitral valve surgery at national heart institute

Abstract

Background Advancements in instruments and thoracoscopes and the evolution of cannulation techniques and cannulae types for cardiopulmonary bypass as well as cardiopulmonary bypass machines during the past decade have encouraged many surgeons to adopt minimally invasive mitral valve surgery (MIMVS). Today, MIMVS has become the standard approach for many surgeons and institutions. Patients and methods This is a nonrandomized prospective study in which 150 patients of mitral valve pathology scheduled for mitral valve surgery over a period of 3 years from March 2014 to May 2017 at National Heart Institute were allocated to two groups after fulfilling the inclusion criteria. Group 1 underwent conventional mitral valve surgery via median sternotomy and group 2 underwent MIMVS via right lateral minithoracotomy. Data were collected prospectively, and seven parameters were used to compare between study groups, namely, cross-clamp time, total bypass time, dose of inotrope, postoperative ventilation time, ICU stay time, total postoperative length of stay, and return to normal activity. Results Demographic criteria of the two cohorts were comparable. Mean bypass time in group 1 was 50.30 ± 7.56 min compared with 67.80 ± 5.85 min in group 2 (P < 0.001). Postoperative ventilation time in group 1 was 8.78 ± 2.1 h and postoperative ICU stay was 49.9 ± 11.55 h, whereas in group 2, postoperative ventilation time was 4.78 ± 1.66 h and postoperative ICU stay was 26.1 ± 7.98 h (P < 0.001 for both). Total postoperative stay was 6.95 ± 1.26 days in group 1 compared with 4.35 ± 1.55 days in group 2 (P < 0.001). Again, return to normal activity was 13.1 ± 4.41 weeks for group 1 compared with 4.45 ± 0.96 weeks in group 2 (P < 0.001). Conclusion In appropriate patients with mitral valve disease of any cause, a right minithoracotomy approach can be used safely without compromising clinical outcome and with fast return to normal activity.