Comparison of Right Anterolateral Thorocotomy with Standard Median Steronotomy for Mitral Valve Replacement

authors:

avatar Zamir Ahmad Shah 1 , avatar Abdual Gani Ahangar 1 , avatar Farooq Ahmad Ganie 1 , * , avatar Shadab Nabi Wani 1 , avatar Mohd Lateef Wani 1 , avatar Hafeezulla Lone 2 , avatar Nasir­ud­din Wani 2 , avatar Irteka Muzamil 3 , avatar Masaratul Gani 4

Department of cardiovascular and thoracic surgery, SKIMS, Soura, Kashmir, India
India
Department of Anesthesia, SKIMS, Soura, Kashmir, India
J and K Health services,. SKIMS, Soura, Kashmir, India
International Cardiovascular Research Journal: Vol.7, issue 1; e12724
published online: March 31, 2013
article type: Research Article
received: May 07, 2017
accepted: December 17, 2012

how to cite: Ahmad Shah Z , Gani Ahangar A , Ahmad Ganie F , Nabi Wani S , Wani M L, et al. Comparison of Right Anterolateral Thorocotomy with Standard Median Steronotomy for Mitral Valve Replacement. Int Cardiovasc Res J. 2013;7(1):e12724. 

Abstract

Obejectives: The objectives of this study were to compare and analyze the results of right anterolateral thoracotomy and median sternotomy approach for primary mitral valve replacement with reference to the exposure during Valve Replacement , length of surgical incision, mean cross clamp time, mean bypass time, intensive care unit (ICU) stay, hospitalization, overall comorbidity with sternotomy; sepsis, dehiscence, healing cosmetic issues and cost effectiveness.
Methods: The present study comprised 68 patients with rheumatic mitral valve disease who underwent mitral valve replacement in the Department ofCardiovascular and Thoracic Surgery at Sher‑i‑Kashmir Institute of Medical Sciences from September 2009 to August 2011.
Results: This study comprised 64 patients with 23 (35.9%) males and 41 (64.1%) females. Sternotomy group had 10 males (31.3%) and 22 females (68.7%). Thoracotomy group had 13 males (40.6%) and 19(59.4%) females. The length of incision between the two groups was statistically significant (P<0.0001). Mean incision length were 24.6±2.1 cm and 14.8±2.3 cm in sternotomy and thoracotomy respectively. Statistically significant difference regarding duration of ICU stay was found between the two groups (P<0.0001). Scar visibility was 100% in sternotomy and around 25% in thoracotomy( P<0.0001).
Conclusions: Thoracotomy through a right anterolateral aspect was easy to perform while maintaining maximum security for the patients. Besides its satisfactory cosmetic result especially in female patients, this approach proved to have several advantages. It offers a better exposure to the mitral apparatus even in patients with small left, allowing easy mitral valve replacement which is apparent from the lower cross‑clamp time in the test group. The invaluable advantage of the above- mentioned thoracotomy is total eradication of the risk of deep sternal infection. The shorter hospital stay and cost effectiveness of thoracotomy approach are additional relief to the family.

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References

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