Comparative evaluation of different access approaches in mitral valve surgery using A.Yu. Sozon-Yaroshevich’s method

Introduction. Surgical treatment of mitral valve diseases remains one of the priority tasks in modern cardiac surgery. The standard access, median sternotomy, provides wide visualization of the operative field but is associated with a high risk of postoperative complications. A promising alternative is the minimally invasive right thoracotomy approach, which reduces trauma while maintaining adequate conditions for the procedure.

Aim: To evaluate and compare the anatomical and surgical characteristics of two access methods to the mitral valve—median sternotomy and right thoracotomy – using the A.Yu. Sozon-Yaroshevich method.

Material and Methods. The study was conducted at the Department of Pathological Anatomy of the State Clinical Hospital of the Presidential Affairs Department of the Russian Federation. A right mini-thoracotomy in the fourth intercostal space and a median sternotomy were performed sequentially on 40 cadavers with no previous open-heart surgery. Using the A.Yu. Sozon-Yaroshevich method, measurements were taken based on three criteria: wound depth, angle of surgical action, and angle of inclination of the surgical axis.

Results. The study included 22 men and 18 women. The average height of the cadavers was 176 ± 10 cm, and the average body weight was 86 ± 14 kg. The wound depth for thoracotomy was 18 (15–21) cm, which was significantly greater than the corresponding measurement for sternotomy, which was 12 (10–16) cm (p < 0.05). The surgical action angle for thoracotomy was 25 (20–28)°, while for sternotomy, it was 69 (48–89)° (p < 0.05). Despite the more limited access parameters in thoracotomy, according to the A.Yu. Sozon-Yaroshevich method, it allows adequate performance of mitral valve interventions.

Conclusion. Right thoracotomy in the fourth intercostal space is a minimally invasive and effective approach for mitral valve surgery. It provides sufficient conditions for performing valve repair and replacement and can be considered a comparable alternative to median sternotomy.

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