APPROACH FOR PRIMARY MITRAL-VALVE SURGERY - RIGHT ANTEROLATERAL THORACOTOMY OR MEDIAN STERNOTOMY

Background and aims of the study: Although both right anterolateral th oracotomy and median sternotomy have been used for mitral valve surger y (repair/replacement), the latter approach is considered standard for primary mitral valve surgery. We hypothesized that primary mitral val ve surgery, if performed through a right anterolateral thoracotomy, wo uld not only be better accepted cosmetically by patients, but also mak e redo surgery through a median sternotomy easy and trouble free from re-entry bleeding. Methods: A right anterolateral thoracotomy was used for primary mitral valve surgeries in 52 patients (group A; 22 males, 30 females) of mean age 30.3 +/- 09.14 years (range: 14 to 50 years). Equal numbers of cases operated on during the same period by via medi an sternotomy were selected retrospectively from hospital records to s erve as controls (group B). Groups were matched with respect to age, b ody weight, body surface area, sex, cardiac rhythm, functional status, type of mitral valve pathology and associated lesions. Results: Opera tive mortality was similar in both groups, but fewer postoperative com plications occurred in group A. Total hospital stay, intensive care un it stay, postoperative bleeding, inotrope requirement and ventilatory support postoperatively was significantly less in group A. Conclusions : Right anterolateral thoracotomy provides excellent exposure of the m itral valve, even with a small left atrium, and offers a better cosmet ic lateral scar which is less prone to keloid formation. In addition, right anterolateral thoracotomy is as safe as median sternotomy for pr imary mitral valve repair/replacement, and should be used as an initia l approach to mitral valve surgery, while median sternotomy be kept fo r repeat mitral valve or other open-heart surgery required later in li fe.