Respiratory complications in valvular heart surgery using two different surgical approaches

Abstract

Introduction: Heart valve surgery (HVS) is a procedure frequently performed in Argentina; between 300 and 500 HVS per million inhabitants per year are performed. The most common respiratory complication in minimally invasive approaches are pneumothorax and pleural effusions. Objective: To analyze respiratory complications in patients with VCS using two different surgical
approaches. Materials and Methods: 200 patients with aortic and mitral valve surgeries were included from
March 2021 to December 2022. The approaches applied were ministernotomy and right lateral thoracotomy.
Patients were ventilated with a protective strategy (plateau pressure less than 30 cm H2O, driving pressure less than 15 cm H2O and low tidal volume). Results: Aortic valve replacement represented 67% (135/200) of valve surgeries, and 91% (124/135) were performed by ministernotomy approach. Mitral valve surgery was performed by right lateral thoracotomy in 57% of cases (32/56). Lobar atelectasis was observed in 8% (13/155) in the ministernotomy arm; while in the right lateral thoracotomy arm, incidence was 15% (7/45) (p=0.259). Second-degree pleural effusion was the most prevalent respiratory complication, manifest in 24% of patients (48/200). There were no differences in the hospital stay between both arms, with a median of 6 days ([CI 5-8 vs CI 4-9] p=0.39). Mortality was 4.5% (9/200). Conclusion: Pleural effusion and lobar atelectasis were the most observed respiratory complications in the postoperative period of HVS by ministernotomy and right lateral thoracotomy respectively.