Choice of an artificial lung ventilation technique for the correction of mitral valve pathology from a mini-thoracotomy approach

Background . In recent years, there has been a growing number of cardiac surgeries performed using minimally invasive techniques. However, there is still debate about the optimal ventilation support for these operations, which are performed through a mini-thoracotomy. The objective was to study the possibility of using high-frequency jet ventilation during minimally invasive mitral valve surgery performed from right-sided mini-thoracotomy, to evaluate its effectiveness and safety. Materials and methods. 80 patients were divided into two groups: one group received high-frequency jet ventilation (HFJV), and the other received low-volume ventilation (LVV). Before surgery, during surgery, and in the intensive care unit, invasive hemodynamic parameters, arterial blood gas composition, and metabolic markers were assessed. The nature and incidence of postoperative complications were also analyzed. Results . In the HFJV group, compared to the LVV group, the level of oxygen tension in arterial blood (PaO 2 ) was significantly higher at 30 minutes after thoracotomy – 307 (220–352) mmHg versus 106 (90–127.5) mmHg, p < 0.001, and at 30 minutes after the end of cardiopulmonary bypass (CPB) – 264 (188–323) mmHg versus 147 (109.5–183.5) mmHg, p < 0.001. PaO 2 /FiO 2 was also higher in the HFJV group compared to the LVV group at these stages – 623 (450–714) versus 214 (171.3–263.3), p < 0.001 and 534 (367–654) versus 260 (200.5 – 358), p < 0.001. The number of patients with a PaO2/FiO2 of 200 or lower in the HFJV group was significantly lower than in the LVV group – 2.5 % compared to 32 %, p < 0,001 before CPB and 5 % compared to 25 %, р = 0,013 after CPB. There was no statistically significant difference between the groups in the number of postoperative pulmonary complications, as well as the duration of artificial lung ventilation (ALV) and stay in the intensive care unit (ICU). Conclusions . The use of high-frequency jet ventilation during minimally invasive mitral valve surgery performed through right-sided mini-thoracotomy provides adequate oxygenation and prevents the development of hypoxemia. This technique does not increase the number of postoperative complications.