Mitral valve surgery using right anterolateral thoracotomy: is the aortic cannulation a safety procedure? Cirurgia valvar mitral via toracotomia ântero-lateral direita: a canulação aórtica é segura?

INTRODUCTION: The right anterolateral thoracotomy is an alternative technique for surgical approach of mitral valve. In these cases, femoral-femoral bypass still has been used, rising occurrence of complications related to femoral cannulation. Objective: Describe the technique and results of mitral valve treatment by right anterolateral thoracotomy using aortic cannulation for cardiac pulmonary bypass (CPB). METHODS: From 1983 e 2008, 100 consecutive female patients, with average age 35 ±13 years, 96 (96%) underwent mitral valve surgical treatment in the Heart Institute of São Paulo. A right anterolateral thoracotomy approach associated with aortic cannulation was used for CPB. Eighty (80%) patients had rheumatic disease and 84 (84%) patients presented functional class III or IV. RESULTS: Were performed 45 (45%) comissurotomies, 38 (38%) valve repairs, 7(7%) mitral valve replacements, seven (7%) recomissurotomies and three (3%) prosthesis replacement. Sparing surgery was performed in 90 (90%) patients. The average CPB and clamp time were 57 ± 27 min e 39 ± 19 min, respectively. There were no in-hospital death, reoperation due to bleeding and convertion to sternotomy. Introperative complications were related to heart harvest (5%), especially in reoperations (3%). The most important complications in postoperative period were related to pulmonary system (11%), followed by atrial fibrilation (10%) but without major systemic repercussions. The mean inhospital length of stay was 8 ± 3 days. Follow-up was 6.038 patients/month. Actuarial survival was 98.0 ± 1.9% and freedom from reoperation was 81.4 ± 7.8% in 180 months. CONCLUSION: The right anterolateral thoracotomy associated with aortic cannulation in mitral valve surgery is a simple technique, reproducible and safety.INTRODUÇÃO: A toracotomia ântero-lateral direita tem sido utilizada como uma alternativa para a abordagem cirúrgica da valva mitral. Nestes casos, a canulação femoral continua sendo utilizada, possibilitando a ocorrência de complicações. OBJETIVO: Descrever a técnica e os resultados do tratamento da valva mitral via toracotomia ântero-lateral direita, utilizando a canulação aórtica para instalação da circulação extracorpórea. MÉTODOS: Entre 1983 e 2008, 100 pacientes consecutivos, com média de idade 35 13 anos, 96 (96%) do sexo feminino, foram submetidos ao tratamento cirúrgico da valva mitral no InCor-HC-FMUSP, através da toracotomia ântero-lateral direita associada à canulação aórtica. Destes,