Non coronary cardiac surgery though a mini thoracotomy in the 4th intercostal space. Is it feasible and safe?

Objectives: Report on the feasibility and safety of non coronary cardiac surgery (NCCS) performed through a mini invasive right thoracotomy in the 4th intercostal space (MIRT) Material and

Methods: From August 2003 to September 2006 84 patients (45 male, age 62.5, mean Euroscore 5.8) underwent a NCCS through a MIRT. There were 31 aortic, 17 mitral, 2 tricuspidal, 3 combined valve replacement, 3 prosthetic valve refixation, 23 mitral valve plasty, 3 ASD closure, 1 myxoma excision, 1 tricuspid plasty. There were 13 redo cases (15.5%). In 51% high epidural thoracic anesthesia was performed. Cardiopulmonary bypass was via right femoral artery and vein and right jugular vein. The videoassisted operation was performed in moderate hypotermia (30°) and cardioplegic arrest. Transthoracic aortic clamping was utilized in almost all cases. Mean operative, perfusion and crossclamp times were 229, 128 and 69min respectively.

Results: Two patients died (2.4%). One patient needed a conversion to sternotomy because of a calcium fragment entrapment in a mechanical prosthesis, 4 (4.8%) patients needed a pacemaker implantation, 6 (7%) underwent reexploration for bleeding and 5 (5.9%) required surgical treatment for groin seroma. Blood transfusion was required in 19% of the cases. In 30% of the cases the extubation was in the OR. Mean follow up is 20±12.3 months

Conclusions: Non coronary cardiac surgery through a MIRT is feasible and safe. Operative time, perfusion and cross-clamping times are only marginally longer than a conventional operation and mortality and morbidity are low.