ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Cardiovascular Surgery
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1625773
Outcomes of isolated mitral valve surgery performed via right anterolateral thoracotomy: a single-centre experience
Provisionally accepted
- Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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The evidence underlying thoracic and pulmonary complications and clinical outcomes after isolated mitral valve surgery performed via right anterolateral thoracotomy is inconclusive. This study retrospectively compared the postoperative thoracic and pulmonary complications and clinical outcomes of isolated mitral valve surgery performed via right anterolateral thoracotomy versus median sternotomy.Methods: Patients data undergoing isolated mitral valve surgery in our institution were analyzed. Propensity score matching was applied to minimize differences between patients undergoing right anterolateral thoracotomy and median sternotomy. Intraoperative parameters, postoperative thoracic and pulmonary complications, and other postoperative outcomes were compared. Outpatient followups were conducted.Of 711 individuals who met study criteria, 298 underwent right anterolateral thoracotomy and 413 underwent median sternotomy surgery. Propensity score matching resulted in 279 matched pairs for further analysis. Patients' characteristics were comparable in the matched cohorts. The right anterolateral thoracotomy group had higher incidences of subcutaneous emphysema (23.3% vs 2.9%, P < 0.001), pneumothorax (12.5% vs 2.5%, P < 0.001), right diaphragmatic elevation (7.5% vs 0.7%, P < 0.001), and massive pleural effusion (3.6% vs 1.1%, P = 0.049) compared to the median sternotomy group. However, the right anterolateral thoracotomy group had lower 24-hour postoperative drainage (median [IQR], 200 [110,350] vs 300 [230,415], ml; P < 0.001), postoperative red blood cell and plasma transfusion volume (median [IQR], 7.0 [4.0,11.0] vs 10.0 [5.5,17.0], U; P < 0.001), ICU stay duration (median [IQR], 2 [2,3] vs 2 [2,3], day; P= 0.004), and postoperative days (median [IQR], 9 [8,11] vs 12 [10,15], day; P < 0.001). Follow-up data of patients in two groups had no significant differences (P > 0.05). Multivariable logistic regression analysis revealed that incision type, age, atrial fibrillation, and coronary heart disease were significant factors influencing postoperative thoracic and pulmonary complications and course (P < 0.05).Conclusions: Isolated mitral valve surgery via right anterolateral thoracotomy was associated with more thoracic and pulmonary complications and shorter 24-hour postoperative drainage, ICU stay duration and postoperative days compared with median sternotomy, which potentially related to the choice of incision site, specific patient conditions, and surgical techniques.
Keywords: Mitral valve surgery, Right anterolateral thoracotomy, Median sternotomy, thoracic and pulmonary complications, outcomes, follow-up
Received: 09 May 2025; Accepted: 15 Jul 2025.
Copyright: © 2025 Huang, Yang, Xie, Chen, Guo and Shi. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jia-Wei Shi, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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