Minimally invasive mitral valve surgery via submammary hidden incision

Background. With the recent advancement in minimally invasive cardiac surgery based on the needs of decreasing costs, hospital stay, recovery time and improving cosmetic appearance, minimally invasive mitral valve surgery (MIMS) is being actively pursued. The objective of this study was to compare our submammary hidden incision method to two other more proven methods of MIMS with respect to length of operation, clinical outcome and cosmetic satisfaction. Methods. From July, 1996 to June, 1998, a total of 14 patients underwent MIMS in our hospital. Three different approaches were used: the limited right-side thoracotomy approach, the parasternal incision approach and our submammary hidden incision approach, of which, this is the first report. All relevant clinical results are reported, including general characteristics of the operations, morbidity and mortality, length of hospitalization, pain relief and patient satisfaction. Results. Five patients underwent MIMS via limited thoracotomy, four via parasternotomy and five with our submammary hidden incision method. There were six mitral valves repaired and eight replaced. Conversion to traditional sternotomy was not necessary in any of the three groups. The results from the three different approaches did not differ significantly across the different parameters measured. Nonetheless, the submammary hidden incision approach showed promise in the areas of length of stay for both intensive care patients (36.3 ± 5.0 hours) and total hospitalization (10.7 ± 0.6 days), pain relief and patient satisfaction. Conclusions. The submammary hidden incision method does not result in any significant disadvantage in clinical outcome. The method resulted in more satisfied patients due to less pain, shorter hospital stay, and most importantly, cosmetic appearance of the resulting surgical scar. We will make the submammary hidden incision approach the MIMS approach of choice at our institution and continue to monitor the long-term results.