title: Video-assisted minimally invasive mitral valve surgery.
abstract: OBJECTIVE
  This study was done to determine the potential benefits of minimally invasive mitral surgery performed with intraoperative video assistance.
  
  
  METHODS
  From May 1996 until March 1997, a minithoracotomy and video assistance were used in 31 consecutive patients undergoing mitral repair (n = 20) and replacement (n = 11). Their ages ranged from 18 to 77 years (59 +/- 2.6 years; mean +/- standard error of the mean). Ejection fractions were 35% to 62% (55% +/- 1.5%). Operations were done with either antegrade/retrograde (n = 10) or antegrade (n = 19) cold blood cardioplegia and a new transthoracic crossclamp or with ventricular fibrillation (n = 2). Peripheral arterial cannulation (n = 28) and pump-assisted right atrial drainage (n = 26) were used most often.
  
  
  RESULTS
  No hospital deaths occurred, but the 30-day mortality was 3.2%. Complications included deep venous thrombosis and a phrenic nerve palsy in one patient each. No patient had a stroke or required reoperation for bleeding. Postoperative echocardiography showed excellent valve function in all but one patient. Cardiopulmonary bypass and arrest times averaged 183 +/- 7.2 and 136 +/- 5.5 minutes, respectively. Compared with 100 patients having conventional mitral valve operations, these patients had significantly shorter hospitalization times (8.6 +/- 0.5 vs 5.1 +/- 0.9 days, p = 0.05). Moreover, 81% of the later cohort were discharged between day 3 and 5 (3.6 +/- 0.2 days). Hospital charges (decreases 27%, p = 0.05) and costs (decreases 34%, p < 0.05) were less than in conventional operations. Patient follow-up suggested minimal perioperative pain and rapid recovery.
  
  
  CONCLUSIONS
  Early results suggest that video-assisted minimally invasive mitral operations can be done safely. These methods may benefit patients through less morbidity, earlier discharge, and lower cost.
authors.affiliation: Division of Cardiothoracic Surgery, East Carolina University School of Medicine, Greenville, NC 27858, USA.
authors.forename: W R
authors.initials: WR
authors.lastname: Chitwood
authors.forename: C L
authors.initials: CL
authors.lastname: Wixon
authors.forename: J R
authors.initials: JR
authors.lastname: Elbeery
authors.forename: J F
authors.initials: JF
authors.lastname: Moran
authors.forename: W H
authors.initials: WH
authors.lastname: Chapman
authors.forename: R M
authors.initials: RM
authors.lastname: Lust
mesh_terms: D002315:Cardiopulmonary Bypass; D015331:Cohort Studies; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation / Q000191:economics / Q000379:methods*; D017722:Hospital Charges; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000191:economics / Q000379:methods; D008943:Mitral Valve / Q000601:surgery*; D012189:Retrospective Studies; D013249:Sternum / Q000601:surgery; D013908:Thoracotomy / Q000379:methods; D014741:Video Recording