Outcomes following totally endoscopic mitral valve replacement versus mitral valve replacement through right thoracotomy: a prospective randomized controlled study.

Abstract

Total endoscopic video-assisted mitral valve replacement represents a comparatively new advancement in cardiac surgery. It is associated with cosmetic benefits, minimal pain, and shorter hospital stay than right anterolateral thoracotomy approach of minimally invasive mitral valve replacement. Our study aims to delineate the advantages and disadvantages of these two minimally invasive techniques along with the relative improvement of quality of life. In this prospective randomized study, 40 patients undergoing isolated mitral valve replacement via right anterolateral thoracotomy approach (group A) and 40 patients undergoing the same procedure using the totally endoscopic method (group B) were randomly selected. Immediate postoperative outcomes, including duration of intensive care unit and hospital stay, were analyzed. Additionally, outcomes were assessed at 1 and 6 weeks, 6 months, and 1 year. Group B exhibited significantly lower pain scores (p - 0.012) and superior postoperative pulmonary function (p <0.001). Cosmesis, return to normal activities, and work were significantly higher in group B (p = 0.029 and p = 0.030 respectively). Left ventricular (LV) function, incidence of valve thrombosis, paravalvular leakage, and mortality rates were similar. A totally endoscopic mitral valve replacement technique provides better quality of life and patient satisfaction, with comparable cardiac function and complication rates to the right anterolateral thoracotomy approach.