Introduction: Minimally invasive cardiac surgery (MICS) has redefined mitral valve replacement (MVR), but its adoption in low- and middle-income countries (LMICs) is limited by resource constraints and cost-effectiveness concerns. This study evaluates single-incision right mini-thoracotomy with central cannulation as a feasible and economical alternative to sternotomy.
Methods: A retrospective analysis was performed on 250 patients who underwent MVR via right mini-thoracotomy with central cannulation between January 2014 and June 2017 at a high-volume tertiary center in Western India. Demographics, New York Heart Association (NYHA) class, valve pathology, operative data, complications, hospital stay, and early outcomes were reviewed. Economic benefit was assessed in terms of hospital stay, recovery, and avoidance of groin-related vascular interventions.
Results: The mean age was 32.5 years, with most patients in the 3rd–4th decades. Rheumatic disease accounted for 89% of cases, degenerative disease 10%, and infective endocarditis 1%. Mean incision length was 7.2 cm. Cardiopulmonary bypass and operative times were comparable to sternotomy, with prolongation in 10% of cases. Drainage was <100 mL in 60% of patients. Most (85%) were discharged by postoperative day 5, with average stay 4–7 days. At two months, 94% of survivors were in NYHA class I–II. Mortality was 0.5%. Cost savings were achieved by shorter hospitalization, faster recovery, and avoidance of groin complications.
Conclusion: Right mini-thoracotomy MVR with central cannulation is safe, reproducible, and cost-effective. It reduces trauma, accelerates recovery, improves cosmesis, and avoids vascular complications, making it a practical minimally invasive option in LMICs.