title: Right Minithoracotomy for Mitral Valve Surgery: Impact of Tailored Strategies on Early Outcome.
abstract: BACKGROUND
  Interest in right minithoracotomy mitral valve surgery (MVS) is rapidly growing and, to date, different perfusion strategies and aortic clamping techniques are available. However each approach carries specific advantages and drawbacks. This retrospective study analyses our experience in right minithoracotomy MVS with different arterial perfusion and aortic clamping strategies, highlighting the results of a patient tailored approach.
  
  
  METHODS
  Between March 2009 and March 2014, 460 patients with a full preoperative work-up that included also aortoiliac-femoral axis' screening underwent right minithoracotomy MVS. One hundred and eight were redo cases (23.5%), 63 had aortoiliac atheromatous disease or significant tortuosity (13.7%), and 38 had chronic obstructive pulmonary disease (8.3%). Based on anatomy and comorbidities, each patient was allocated to the most appropriate of 3 approaches: femoral arterial cannulation with endoaortic balloon (P+EB) (247, 53.7%) or with transthoracic clamp (P+XC) (150, 32.6%), and direct aortic cannulation with endoaortic balloon occlusion (C+EB) (63, 13.7%).
  
  
  RESULTS
  No cases of aortic dissection were reported. Early outcome were similar between the 3 groups; no differences were reported in terms of stroke rate (1.7% in the P+EB, 2% in the P+XC, and no cases in the C+EB group; p = NS) and 30-day mortality (2.1% in the P+EB, 2.7% in the P+XC, and 1.6% in the C+EB group; p = NS). Logistic regression showed no influences of arterial perfusion and aortic clamping techniques on 30-day mortality and stroke.
  
  
  CONCLUSIONS
  Right minithoracotomy MVS can routinely be performed with favorable outcomes in all comers when perfusion strategies and clamping techniques are carefully selected after proper evaluation of the patient's preoperative characteristics.
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, University of Turin, Torino, Italy. Electronic address: cristina.barbero@unito.it.
authors.forename: Cristina
authors.initials: C
authors.lastname: Barbero
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, University of Turin, Torino, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Marchetto
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, University of Turin, Torino, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Ricci
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, University of Turin, Torino, Italy.
authors.forename: Suad
authors.initials: S
authors.lastname: El Qarra
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, University of Turin, Torino, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Attisani
authors.affiliation: Department of Anesthesia and Critical Care, University of Turin, Torino, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Filippini
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, University of Turin, Torino, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Boffini
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, University of Turin, Torino, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Rinaldi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001018:Aortic Diseases / Q000453:epidemiology; D021721:Balloon Occlusion; D002404:Catheterization; D015897:Comorbidity; D003250:Constriction; D005263:Femoral Artery; D006801:Humans; D007083:Iliac Artery; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D008943:Mitral Valve / Q000601:surgery*; D018579:Patient Selection; D010477:Perfusion / Q000379:methods; D058226:Plaque, Atherosclerotic / Q000453:epidemiology; D011300:Preoperative Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D012086:Reoperation; D012189:Retrospective Studies; D013908:Thoracotomy / Q000379:methods*; D016896:Treatment Outcome