Video assisted minimally invasive mitral valve replacement in rheumatic valve disease.

Abstract

Objective: Assessment early outcome of video assisted minimally invasive mitral valve replacement, in rheumatic valve disease. Also, to evaluate early postoperative quality of life by SF 36 questionnaire. Methods: This is a prospective single center study which was conducted on 20 rheumatic heart patients, in Egypt; during the period from October 2015 to June 2018. The main pathological lesion was sever mitral regurgitation (MR), mitral stenosis (MS) or both. Patients underwent video assisted minimally invasive mitral valve replacement, through a right mini thoracotomy. 13 patients (65%) were via infra-mammary incision, 4 patients (20%) were via periareolar incision and 3 patients (15%) were via limited right anterolateral mini-thoracotomy. Results: Mean length of surgical incision was (6.60 ± 1.35 cm). Mean duration of operation, cardiopulmonary bypass, and cross clamp times were (4.32 ± 1.08 hr.), (2.85 ± 0.75 hr.) and (1.78 ± 0.47 hr.) respectively. ICU stay was 2.35 ± 1.14 days and Hospital stay was 6.45 ± 1.43 days. The mean amount of blood loss was 398.50 ± 245.79 ml with two patients of bleeding requiring re-opening. At discharge, all patients had normal mitral prosthetic valve function with no or trivial regurgitation, as shown by echocardiographic studies. The postoperative quality of life revealed faster recovery of usual activities. Conclusions: Video assisted minimally invasive mitral valve surgery in the surgically challenging rheumatic valve disease has less surgical trauma, blood loss and pain, which translates into short hospital stay, rapid return to normal activities, less use of resources.