Immediate results of correction of atrio-ventricular valve defects through right-sided video-assisted minithoracotomy

Purpose: To evaluate the immediate results, safety and replicability of the method of correction of atrioventricular valve defects through right-sided video-assisted minithoracotomy based on the first experience of 37 operations.

Materials and Methods: from March 2022 to October 2023, 37 adult patients underwent correction of isolated and combined mitral and tricuspid valve lesions via right-sided video-assisted minithoracotomy. There were 21 (56.7%) females in the group, and the age of the patients was 49±10 years. Overweight (BMI 25-30) was identified in 11 (29.7%) patients. Single-valve intervention was performed in 25 (67.6%) patients, two-valve correction in 12 (32.4%). The EuroScore II risk was 1.3±0.7%.

Results: Cardiopulmonary bypass time was 184±41 min, aortic cross-clamping time was 131±34 min. Valve reconstruction was performed in 25 (67,6%) patients. Intraoperative blood loss was 490±115 ml, component transfusion was performed in 3 (8%) patients. Converting from minithoracotomy to midline sternotomy was in 1 (2,7%) patient. The duration of ALV was 15.9±16.7 hours, the duration of stay in the intensive care unit (ICU) was 22±15.9 hours, and the duration of postoperative hospital stay was 10±2.8 days. There were no incident atrial fibrillations in the postoperative period in any patient. There were also no cases of deep wound infection, ACVA and fatal outcomes. In one case (2.7%) the patient developed postoperative delirium, which required prolonged ALV.

Conclusion: Correction of atrio-ventricular valve defects through right-sided video-assisted minithoracotomy is a safe intervention because it is associated with a low rate of post- and intraoperative complications and conversion to midline sternotomy. Less blood loss and quicker recovery of patients compared to standard surgery. This technique can be safely applied both in patients with isolated mitral valve defects and with combined atrio-ventricular valve defects. Correction of atrio-ventricular valve defects through right-sided video-assisted minitorcotomy is a reproducible operation, but it is more demanding on surgical skills and requires patient selection, especially at the stage of technology implementation.

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