Authors
Eliseev I.G.1, Lischuk A.N.1, Havandeev M.L.1, 2, Komendantova Yu.V.3, Gitelzon E.A.4, Faibushevich A.G.4
1 National Medical Research Center of High Medical Technologies – the Central Military Clinical Hospital of A.A. Vishnevsky, Krasnogorsk
2 Institute of Emergency and Reconstructive Surgery named after. V.K. Gusak, Donetsk
3 Russian State Social University, Moscow
4 RUDN University, Moscow
Abstract
Aims: to compare the efficacy and safety of mitral valve (MV) prosthesis using different surgical accesses (median sternotomy and lateral thoracotomy) in overweight patients; to evaluate the influence of the choice of access on complications, quality of life, survival and cardiac function, as well as to determine the risk factors for complications in combined surgical treatment of coronary heart disease and MV prosthesis.
Methods: Patient groups were formed depending on the type of surgical access: 50 patients underwent MV prosthesis through median sternotomy, and 80 patients underwent MV prosthesis through lateral thoracotomy. The study design was a retrospective cohort study. Surgical interventions were performed between 2015 and 2023. 130 overweight patients (BMI >30 kg/m2) with MV lesions were included in the analysis. Quality of life before and after surgery was assessed using the standard SF-36 questionnaire. Operative risk was assessed using Euroscore II scale, comorbid background was evaluated using Charlson comorbidity index. Statistical methods were used to analyze quantitative features: Student's t-test, Mann-Whitney test, and mixed general linear models.
Results: The use of lateral thoracotomy, in comparison with median thoracotomy, contributed to a more pronounced reduction in pain intensity and improved quality of life in most of the parameters assessed by the SF-36 questionnaire, including physical, lifestyle, social and emotional functioning, as well as physical pain, general health and vitality.
Conclusion: According to the results of the study, MV prosthesis using lateral sternotomy can be considered as a preferable method in overweight patients, as it is characterized by shorter duration of surgery, artificial circulation, artificial ventilation, and duration of hospitalization. Both types of access provide pronounced improvement of hemodynamic parameters and reduction of the functional class of chronic heart failure according to NYHA without statistically significant differences between the groups. However, when combined surgical treatment of ischemic heart disease is necessary, the choice of access should be based on the assessment of the risk of progression of the underlying chronic kidney disease.
Keywords: mitral valve, prosthesis, sternotomy, minithoracotomy, obstructive pulmonary disease, ischemic heart disease.
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