title: Mitral valve replacement through a minimal right vertical infra-axillary thoracotomy versus standard median sternotomy.
abstract: BACKGROUND
  Minimally invasive valve surgery is becoming a safe and cosmetic alternative to standard median sternotomy (SMS). This retrospective study reviews our results and experience with a right vertical infraaxillary thoracotomy (RVIAT) technique for mitral valve replacement (MVR) compared with SMS.
  
  
  METHODS
  Between December, 2003 and February, 2007, 192 patients underwent MVR through RVIAT (group 1). This group was compared with 203 patients who underwent MVR using SMS during the same period (group 2).
  
  
  RESULTS
  Hospital mortality was 1 of 192 (0.5%) patients in group 1 and 1 of 203 (0.5%) patients in group 2 (p > 0.05). There was no late death in either group. The mean length of incision was significantly shorter in group 1 than that in group 2 (8.7 +/- 2.2 cm vs 23.5 +/- 2.5 cm, p < 0.05). The time to establish cardiopulmonary bypass was longer in group 1 (35.8 +/- 7.6 vs 28.3 +/- 6.5 minutes, p < 0.05). Group 1 had less chest drainage than group 2 (171 +/- 21 vs 336 +/- 46 mL, p < 0.05) and required less blood transfusion (159 +/- 19 vs 446 +/- 16 mL, p < 0.05). Postoperative mechanical ventilation time was also less in group 1 (4.5 +/- 1.2 vs 6.5 +/- 3.2 hours, p < 0.05). There were no statistical differences in aortic cross-clamp time, cardiopulmonary bypass time, and total operation time between the two groups.
  
  
  CONCLUSIONS
  The RVIAT can be performed with favorable cosmetic and clinical results. It provides a good alternative to standard median sternotomy for MVR.
authors.affiliation: Department of Thoracic Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Peoples Republic of China.
authors.forename: Dongjin
authors.initials: D
authors.lastname: Wang
authors.forename: Qiang
authors.initials: Q
authors.lastname: Wang
authors.forename: Xiubin
authors.initials: X
authors.lastname: Yang
authors.forename: Qingyu
authors.initials: Q
authors.lastname: Wu
authors.forename: Qingguo
authors.initials: Q
authors.lastname: Li
mesh_terms: D000328:Adult; D001365:Axilla; D006348:Cardiac Surgical Procedures / Q000379:methods; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D012189:Retrospective Studies; D013249:Sternum / Q000601:surgery; D013908:Thoracotomy / Q000379:methods*; D055815:Young Adult