الفهرس 
Introduction And Aim Of The WorkOnly 14 pages are availabe for public view
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Abstract
In this study 40 patients with isolated mitral valve disease requiring primary mitral valve replacement were randomized in two groups:
group “A”: Patients undergoing mitral valve surgery through right anterolateral mini-thoracotomy (RALMT).
group “B”: Patients undergoing mitral valve surgery through median sternotomy (MS).
There was no statistically significant difference as regards the age, sex, BMI, rhythm, preoperative echocardiographic findings as the left ventricular contractility EF, right ventricle, PAP and left atrial dimension.
Intraoperative values show that, there was statistically significant difference in the cross-clamp time, total bypass time, total operation time being shorter in MS group.
Regarding the intensive care parameters, the mechanical ventilation time was shorter in group “A” but with no significant difference between the two groups , the blood loss was statistically significant being less in group ”A”, and the blood transfusion required was lesser in group “A” but with no statistically significant difference between the two groups.
The ICU stay was shorter in group “A” but with no statistically significant difference between the two groups. Also the total hospital stay was less in group “A”, but with no statistical difference between the two groups.
The complications of group “A” were near in degree of importance to those of group “B”, but there was no statistical significance regarding the number of complicated patients.
As regards wound satisfaction, it was markedly higher in group “A” than in group “B” because the scar of ALMT was cosmetically accepted than that of MS and there was high statistically significant difference between the two groups.
ALMT is as safe as MS in primary mitral valve surgery. In our study, the length of skin incision was 7-5 cm then progressed to smaller skin incision. Specially developed telescopic instruments for minimally invasive cardiac surgery procedures were used. The exposure of the mitral valve was excellent even in patients with small left atrium. But this needs specific instruments, harmony between team members and planed learning curve to master this technically demanding technique.
Primary mitral valve surgery, if performed through a right ALMT would not only be better accepted cosmetically by patients, but also make redo surgery through MS easy and trouble free from reentry bleeding.