Article
Extended indications of operative spectrum via right lateral mini-thoracotomy
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Published: | April 23, 2012 |
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Introduction: A right lateral mini-thoracotomy with femoral cannulation for cardiopulmonary bypass is an increasingly used approach for mitral valve surgery (MVS). Outcomes after procedures other than MVS have not been well described.
Materials and methods: We retrospectively reviewed 168 cardiac operations via right lateral mini-thoracotomy (MIC) with femoral cannulation between 8/2009 and 7/2011. We investigated the short-term morbidity and mortality with regard to the surgical procedure and 1-year-follow-up data including echocardiography.
Results: Of the 168 MIC-Patients, 120 had isolated mitral valve operations (102 repairs, 18 replacements). Furthermore, there were 30 combined procedures with additional surgery of the tricuspid valve (TV) ( including 7 procedures with removal of infected pacemaker- or ICD-leads), 5 patients with an isolated TV-procedure, 6 patients with resection of atrial tumors, 7 cases of closure of atrial septal defects.
Overall in-hospital mortality was 4.8% (8 of 168). In the indivdual groups, it was each 3.3 % in the groups of patients with isolated MV-surgery and with combined procedures, and 20 % (1 of 5) in the isolated TV-group. In patients with resection of tumors or ASD-closures no in-hospital mortality could be observed.
Length of ICU - and hospital-stay were 1.8 ± 2.1 days and 11.7 ± 4.8 d in all 168 patients (Isolated MVS: 1.3 ± 0.8 d, 11.3 ± 3.3 d; other groups: 2.9 ± 2.8 days, 11.9 ± 5.2 d, respectively).
At follow-up, survival was 94.6 % in total. Freedom from reoperation was 92.8 %. Mean left ventricular ejection fraction decreased from 61.8 ± 10 % at hospital discharge to 58.9 ± 9.7 % (p > 0.05) at follow in all patients.
Conclusion: Right lateral mini-thoracotomy is a routinely used access for MV-surgery. With our data we could confirm this technique for a wide spectrum of operative procedures that can also be performed with excellent results.