Abstract:Objective: To compare the right vertical infra-axillary thoracotomy for mitral valve repairment with standard median sternotomy. Methods: A total of 93 patients,divided into a right vertical infra-axillary thoracotomy group and a standard median sternotomy group,who underwent mitral valvuloplasty from January 2002 to November 2010 were analyzed retrospectively. Results: Hospital mortality was 1 of 36 (2.8%)patients in the right vertical infra-axillary thoracotomy group and none in the standard median sternotomy group. There was no late death in either group. The time to establish cardiopulmonary bypass was longer in the right vertical infra-axillary thoracotomy group(P <0.05). The right vertical infra-axillary thoracotomy group had less chest drainage during the postoperative 24 hours than the standard median sternotomy group and required less blood transfusion(P <0.05). Postoperative mechanical ventilation time was also less in the right vertical infra-axillary thoracotomy group(P <0.05). There were no statistical differences in aortic cross-clamp time,cardiopulmonary bypass time,and total operation time between the two groups. Conclusion: The right vertical infra-axillary thoracotomy can be performed with favorable cosmetic and clinical results. It provides a good alternative to standard median sternotomy for mitral valve repairment.
[1] Yang X, Wang D,Wu Q.Repair of atrial septal defect through a minimal right vertical infra-axillary thoracotomy in a beating heart[J].Ann Thorac Surg,2001,71(6): 2053-2054. [2] Yang X, Wang D, Wu Q, Repair of partial atrioventricular septal defect through a minimal right vertical infra-axillary thoracotomy[J].J Card Surg,2003,18(3):262- 264. [3] Wang D, Wang Q, Yang X, et al. Mitral valve replacement through a minimal right vertical infra-axillary thoracotomy versus standard median sternotomy[J].Ann Thorac Surg,2009,87(3):704-708. [4] Tünerir B,Aslan R. An alternative, less invasive approach to median sternotomy for cardiac operations in adults: right infra-axillary minithoracotomy[J].J Int Med Res,2005,33(1): 77-83. [5] Gazoni LM, Fedoruk LM, Kern JA, et al. A simplified approach to degenerative disease: triangular resections of the mitral valve[J].Ann Thorac Surg,2007,83(5):1658 -1664. [6] Gillinov AM,Cosgrove DM. Chordal transfer for repair of anterior leaflet prolapse[J].Semin Thorac Cardiovasc Surg,2004,16(2):169-173. [7]王巍,孙海宁,宋云虎,等.二尖瓣成形术367例分析 [J].中国循环杂志,2008,23(6):452-455.