Right anterolateral thoracotomy as an alternative approach to resternotomy for high-risk cardiac surgery patients

Abstract

Introduction Redocardiac valve surgery through median sternotomy is associated with a potential increased risk of morbidity and mortality. The study was done at the National Heart Institute of Egypt from June 2016 to June 2018 to evaluate the right anterolateral thoracotomy for high-risk patients undergoing mitral and tricuspid valve redo procedures. Patients and methods This study includes 26 patients operated through right anterolateral thoracotomy which include high-risk group on the basis of the proximity of sternum to the right ventricle or great vessels, mainly ascending aorta. Moreover, the presence and location of patent grafts were assessed. Results In right submammary thoracotomy group, the mitral valve was replaced in 19 patients and repaired in two, and tricuspid valve was replaced in two and repaired in five patients. Mortality was 7.69%. Conclusion Redocardiac valve surgery in high-risk patients can be performed safely through the right submammary thoracotomy with good exposure. It minimizes the need for surgical dissection and decreases the risk for accidental injury. So, in high-risk patients, avoiding resternotomy improves patient's recovery and increases safety for redo mitral and tricuspid valve surgery.

Keywords

• right anterolateral thoracotomy
• resternotomy
• high-risk redo cardiac surgery