Abdul Malik, Muhammad Asghar, Tariq Farman, Nasreen Laiq, Rad Ali Shah S Murad, Riaz Anwar Khan.
Standard median sternotomy versus right anterolateral thoracotomy for mitral valve replacement.
J Med Sci Jan ;23(1):42-5.

Objective: To compare the morbidity and mortality of standard median sternotomy with right anterolateral thoracotomy for procedure of mitral valve replacement. Materials and Methods: All patients who were selected for mitral valve replacement in the department of Cardiovascular Surgery Lady Reading Hospital were included in the study. They were randomly assigned to one of the group. Group I patients of SMS and Group II Patients of RALT. Patients of both groups were operated as per standard protocols of the procedures for mitral valve replacement. All patients had a similar pre and post operative care. The groups were compared for aortic cross clamp time, procedure time, mortality, hospital stay etc. Results: Total of 281 cases was included in the study. There were 204 cases in group I of SMS and 77 in group II of RALT. Female were 73% in group I and 76% in group II. Mean age of patients in group I was 28 ± 11 years and in group II was 26± 12 years. Almost all patients were having rheumatic mitral valve disease. Mean CPB time was 92±12 mints in group I while 100±14 in group II with a p value of <0.0001 Aortic cross clamp time was 61± 15 mints in group I and 69±12 mints in group II which was statistically significant. Ventilation time in group I was 8.9±0.8 hours and 6.75±1 hour in group II with significant p valve of <0.0001. 6.86% of patients died in group I compared to 5.2% of group II which is not statistically significant. None of the patients with RALT were reopened compared to 10(4.875%) of the patients with SMS which was highly significant with a p value of 0.001. Similarly infection did not occur in any patient in RALT group compared to 6(2.92%) patients of SMS group. Conclusion: Right anterolateral thoracotomy for mitral valve replacement in a selected group of patients was safe with fewer per and postoperative morbidity and mortality compared standard median sternotomy.

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