Minimally invasive on-pump mitral valve replacement via right mini-thoracotomy: report of 20 cases

Objective To explore the feasibility of the on-pump right mini-thoracotomy technique for the minimally invasive treatment of mitral disease, and evaluate its value of clinical application. Methods From September 2016 to May 2017, a consecutive series of 20 patients underwent minimally mitral valve replacement via right mini-thoracotomy, including 6 males and 14 females. The average age was (55±3.8), range from 39 to 72.The surgical access was through the right fourth intercostal space, with the length of incision about 6-10 cm.The cardiopulmonary bypass was then established by femoral artery cannulation, insertion of atrio-vena caval catheter, and direct trans-thoracic aortic occlusion. Mitral valve was exposed by left atriotomy and replaced on the arrested heart. Results All the operations were successfully performed with no operative death. The mean cardiopulmonary bypass time was (150.3±37.2) min(range, 118-205 min) and mean aortic clamp time was (133.5±27.4) min(range, 98-189 min). Postoperative ventilation time averaged (11.1±10.4) h, ICU stay averaged (1.3±0.5) d, and hospital stay averaged (7.3±1.7) d. After a mean follow-up of (2.1±1.7) months, all valves were in proper place and with normal functions. No perivalvular leakage and fatal cardiocerebral complications were observed. Conclusions As a promising transitional minimally invasive technique towards the totally thoracoscopic mitral valve replacement, right mini-thoracotomy mitral valve replacement was proved to be a safe and feasible option with satisfactory early-term results. Key words: Heart valve prosthesis implantation; Mitral valve stenosis; Mitral valve Insufficiency; Minimally invasive; Right thoracotomy; Extracorporeal circulation