Comparison of TCP versus PCP during MVR

Abstract

Introduction: Minimally Invasive Cardiac Surgery (MICS) aims at reducing the sequely and complications of currenlly used longer incisions, such as bleeding, pain, infection and lack of cosmesis.Methods: We report our experience with MICS. Mitral Valve Replacement was done through a limited right anterior thoracotomy of about 6-7 cm. Those cases in which the incision was extended due to any reason was discarded from our study. We performed 10 MVR's through right anterior thoracotomy of which & cases were females in the age group of 16-35 years and were suffering from with Rheumatic mitral valve disease. CPB was established with open rt femoral artery and direct rt atrial bicaval cannulation. Aortic cross clamp (Cbitwood) was introduced trans-thoracically through a stab incision in rt anterior axillary line in 2nd intercostals space. Antegrade cold blood cardioplegia was given. MVR was carried out through LA in 8 cases, which was right in front by this approach and via rt atrial tras-septal approach in 2 cases requiring Tricuspid valve annuloplasty for associated TR. The average CPB time was 65 minutes with aortic cross clamp time of 50 minutes. Most of patients were extubated after about 6 hrs. ICU stay was of 2 days. Thoracic Epidural was given in all access with excellent analgesia. Average postoperative drainage was 225 ml. None of the patients required re-exploration for bleeding.Results: 8 cases of AVR and 01 case requiring DVR was bone via small skin incision with mini sternotomy. To gain space in 3 cases CPB was established via open rt femoral artery and direct rt atrial cannulation. Patients were relatively pain free because of sternal stability after mini-sternotomy. Here also it was observed that average postoperative drainage was less as compared to the standard procedure via full sternotomy.Conclusions: Wilh MICS the bleeding was less, reduced less and hospital stay, less pain, better cosmesis. earlier return to normalcy. MICS is paradigm for future.