Perioperative outcomes of video-assisted versus right anterior thoracotomy mitral valve replacement: an observational study

Abstract

Background
Minimally invasive mitral valve surgery has been introduced as a safe alternative to full sternotomy through smaller chest wall incisions to reduce the potential sternal complications in addition to the favorable aesthetic effect. This observational study has been designed to evaluate and compare operative and short-term postoperative outcomes of video-assisted versus right anterior thoracotomy mitral valve replacement. The study was conducted on 40 cases and divided into two groups: group 1, comprised of 20 patients who underwent video-assisted mitral valve replacement (VAMVR), and group 2, comprised of 20 patients who underwent right anterior mini-thoracotomy mitral valve replacement (ATMVR). Preoperative data, intraoperative procedures, and early postoperative results have been compared between both techniques.


Results
Intraoperative parameters showed no statistical difference between the two groups. Wound length in the VAMVR group was statistically smaller than the ATMVR group, 5.33 ± 0.96 cm versus 7.08 ± 1.24 cm, respectively (P < 0.001). The intraoperative assessment by TEE showed a well-suited, well-functioning prosthetic valve, and no paravalvular leak in the two groups. In both groups, there were statistically significant reductions in left ventricular end diastole, left atrial diameter, and pulmonary artery systolic pressure in the 3-month postoperative ECHO in comparison to the preoperative ECHO (P < 0.001). There was a statistically significant decrease in left ventricular end-systole in the VAMVR group in the 3-month postoperative ECHO in comparison to the preoperative ECHO (P < 0.001). ICU visual analog scale (VAS) was significantly lower in the VAMVR group than in the ATMVR group (P = 0.049). There was a gradual reduction in VAS in both groups along the period of 3 months postoperatively without significant differences between the two groups in 2 weeks and 3 months postoperatively.


Conclusions
VAMVR and ATMVR could be considered safe, feasible approaches with favorable perioperative surgical and echocardiographic results. VAMVR showed statistically significant smaller wounds and less postoperative pain than ATMVR, which may offer potential advantages in terms of reduced postoperative discomfort and cosmetic appearance for the thoracoscopic technique. Further randomized studies with larger cohorts and longer follow-ups are recommended to evaluate the long-term benefits and safety of both techniques.