VIDEO ASSISTED MINIMAL INVASIVE MITRAL VALVE REPAIR VS CONVENTIONAL IN DEGENERATIVE MITRAL VALVE DISEASE

Background: The lateral thoracotomy approach for mitral valve surgery was used extensively in the early history of open-heart surgery. Postoperative sternal wound complications are the major problem with sternotomy incision, other disadvantages of median sternotomy is the bad cosmetic appearance of the scar, which is more prone to keloid formation.
Aim of the Work: To compare the procedure and early postoperative outcome of the standard sternotomy approach for mitral valve repair surgery versus the video assisted minimally invasive approach through right anterolateral minithoracotomy.
Patients and Methods: This study is a randomized, controlled and prospective study. It was conducted on 66 patients suffering from MVD selected randomly (purposive non probability sample) to compare procedure and early outcome of traditional sternotomy versus video assisted minimal invasive technique. Patients were divided into two groups of 33 cases, Group "A" underwent mitral valve surgery through video assisted minimally invasive right anterolateral video-assisted minithoracotomy, while group 'B" underwent mitral valve repair surgery through a conventional median sternotomy from 2020 to August 2021.
Results: There was no statistically significant difference as regards the age, sex, NYHA, preoperative echocardiographic findings. Regarding intraoperative comparison, there was highly statistically significant difference in the cross-clamp time, total bypass time and total operative time, this difference may be due to the new experiences in MIMVS. The length of the incision was highly significantly lesser in group "A" than in group "B", There was significant difference in the intensive care parameters. The mechanical ventilation time was shorter in group "A", the blood loss and the blood transfusion required was lesser in group "A". The ICU stay was shorter in group "A". There was significantly less postoperative pain in group (A) than in group (B). Total hospital stay was less in group (A) than in group (B). The complications of group "A" were less serious than those in group "B" but there was no statistical significance. MIMVS was more cost effective than sternotomy group.
Conclusion: In patients with mitral valve disease, minimally invasive surgery may be an alternative to conventional mitral valve surgery. Right anterolateral minithoracotomy provides excellent exposure of the mitral valve and offers a better cosmetic lateral scare comparable short-term mortality. Comparable in-hospital morbidity (renal, pulmonary, cardiac complications, and readmissions), Reduced pain perception, transfusions, postoperative blood loss, duration of ventilation, ICU, hospital length of stay and early return to normal life activity in minithoracotomy than conventional sternotomy.