Minimally invasive correction of mitral valve defects from right-sided minithoracotomy under ‘direct vision control’

Purpose: To evaluate the immediate results of mitral defect correction from right sided lateral minithoracotomy.

Materials and Methods: From August 2021 to September 2023, 30 patients with mitral valve defects underwent surgical correction of mitral defect through right sided lateral minithoracotomy under direct visual control. The indications for the minimally invasive approach were the presence of mitral valve defect without concomitant coronary artery disease requiring revascularisation, absence of aortic insufficiency of more than 1 degree. Among the operated patients there were 19 (63,3%) women and 11 (36,7%) men. The mean age was 48.1±18.8 years. Body mass index was 24.8±6.3 kg/m. The insufficiency was a haemodynamic variant of the defect in 27 patients (90%).

Results: The mean volume of postoperative blood loss was 272±87 ml. The mean time on ALV was 8±3 hours. The mean time in the intensive care unit was 22.6±15.3 hours. There were no repeated interventions and transfusion of blood components in the group of operated patients. There was no hospital mortality, AMI and ACVA among the operated patients. There was no surgical site infection, lymphorrhoea. Pneumothorax requiring drainage was detected in one (3.3%) case. A first-time paroxysm of heart rhythm disturbance (atrial fibrillation/flutter) was recorded in 7 (23%) patients. The average time of hospital stay was 11,9±7 days.

Conclusions: Minimally invasive correction of mitral valve defects from right-sided minithoracotomy under direct visual control is a safe and reproducible operation. IV i/s access provides optimal visualisation of the mitral valve, allowing to perform the whole range of both reconstructive techniques and MV prosthetic repair without the use of video-assisted surgery. In case of proper selection of patients for this type of intervention, the operation is associated with a low incidence of complications in the perioperative period. Preservation of the thoracic cage framework, absence of complications associated with traditional access, and early activation of the patient, combined with an excellent cosmetic effect, contribute to a shorter hospital stay.

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