TITLE:
“A Prospective Randomized Case-Control Study To Evaluate Mini Right Thoracotomy versus Conventional Sternotomy For Mitral Valve Repair In Rheumatic Heart Disease.”
AUTHORS:
Ashok Kumar Chahal, Preeti Gehlaut, Sanjay Johar, Ashish Asija, Divya Arora, Naveen Malhotra, Kuldeep Singh Lallar, Shamsher Singh Lohchab
KEYWORDS:
“Rheumatic Heart Disease, Minimally Invasive Mitral Valve Repair, Right antero-lateral thoracotomy.”, Mitral valve repair
JOURNAL NAME:
World Journal of Cardiovascular Surgery,
Vol.6 No.11,
November
4,
2016
ABSTRACT: Purpose: Right mini thoracotomy has been evaluated in many studies for mitral valve
repair mainly in degenerative valvular disease but not in rheumatic heart disease.
Mitral valve repair is more challenging in rheumatic etiology due to complexity of lesions.
This prospective randomized case control study was designed to evaluate repair
through mini right thoracotomy and to compare the clinical and echocardiographic
outcomes with sternotomy in rheumatic patients. Methods: 25 patients of
rheumatic heart disease underwent mitral valve repair through mini right thoracotomy
(group I). Various clinical and functional parameters were compared with 25
patients of mitral valve repair through sternotomy (group II). On follow up the results
were compared in both groups for clinical and echocardiographic parameters.
Results: The various pre-operative demographic parameters were comparable in two
groups. Equal rate of mitral valve repair (group I-21/25, 84% and group II-21/25,
84%) was achieved in both groups. The various intra-operative and post-operative
clinical parameters were better in group I .There were equivalent functional and
valve related outcomes in both groups in term of NYHA class (1.28 ± 0.613 vs 1.08 ±
0.276, P = 0.144), post-operative mitral valve area (2.43 ± 0.891 vs 2.82 ± 0.662, P =
0.090), incidence of more than mild mitral regurgitation (0) and mean pressure gradient
across mitral valve (4.98 ± 3.33 vs 4.23 ± 1.5, P = 0.309). Conclusion: Mitral
valve repair through mini right thoracotomy approach in rheumatic etiology is feasible
and safe with equivalent rate of successful repair as compared to median sternotomy. It is associated with lesser morbidity, cosmetic advantage and lesser resource
utilization.