STANDARD MEDIAN STERNOTOMY VERSUS RIGHT ANTEROLATERAL THORACOTOMY FOR MITRAL VALVE REPLACEMENT
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Abstract
Objective: To compare the morbidity and mortality of standard median sternotomy with right anterolateral thoracotomy
for procedure of mitral valve replacement.
Material and Methods: All patients who were selected for mitral valve replacement in the department of Cardiovascular
Surgery Lady Reading Hospital were included in the study. They were randomly assigned to one of the group. Group
I patients of SMS and Group II Patients of RALT. Patients of both groups were operated as per standard protocols of
the procedures for mitral valve replacement. All patients had a similar pre and post operative care. The groups were
compared for aortic cross clamp time, procedure time, mortality, hospital stay etc.
Results: Total of 281 cases was included in the study. There were 204 cases in group I of SMS and 77 in group II of
RALT. Female were 73% in group I and 76% in group II. Mean age of patients in group I was 28 ± 11 years and in group
II was 26± 12 years. Almost all patients were having rheumatic mitral valve disease. Mean CPB time was 92±12 mints
in group I while 100±14 in group II with a p value of <0.0001 Aortic cross clamp time was 61± 15 mints in group I and
69±12 mints in group II which was statistically significant. Ventilation time in group I was 8.9±0.8 hours and 6.75±1
hour in group II with significant p valve of <0.0001. 6.86% of patients died in group I compared to 5.2% of group II which
is not statistically significant. None of the patients with RALT were reopened compared to 10(4.875%) of the patients
with SMS which was highly significant with a p value of 0.001. Similarly infection did not occur in any patient in RALT
group compared to 6(2.92%) patients of SMS group.
Conclusion: Right anterolateral thoracotomy for mitral valve replacement in a selected group of patients was safe with
fewer per and postoperative morbidity and mortality compared standard median sternotomy.
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