Minimally invasive port-access mitral valve surgery.
OBJECTIVE
This study evaluates the feasibility of video-assisted minimally invasive mitral valve surgery by means of the Port-Access system. The aim of the study was to minimize surgical access and to develop a video-assisted surgical technique.


METHODS
The Port-Access system allows for closed chest endoluminal aortic clamping, cardioplegic arrest, and decompression of the heart. The mitral valve was either repaired (n = 28) or replaced (n = 23) in 51 patients by means of a minimally invasive approach through a right lateral minithoracotomy and under videoscopic guidance.


RESULTS
Mean length of incision was 5.4 +/- 1.8 cm (range 3.8 to 8 cm). Mean duration of operation, cardiopulmonary bypass, and crossclamp time was 196 +/- 53, 133 +/- 52, and 72 +/- 27 minutes, respectively. Median intubation time was 25.5 hours (range 5 to 264 hours). Median duration of intensive care and hospital stay was 2 days (range 1 to 36 days) and 13 days (10 to 36 days), respectively. Hospital mortality was 9.8% (5/51). Overall morbidity was relatively high. In two patients acute retrograde aortic dissection led to conversion of the procedure. At follow-up (261 +/- 13 days), three patients required reoperation for paravalvular leakage. Baseline mean Duke activity index score was 19.3 +/- 11.3 before the operation and increased to 23.2 +/- 10 at 6 weeks' and 24.2 +/- 10.3 at 12 weeks' follow-up, respectively.


CONCLUSIONS
The Port-Access system allows for video-assisted minimally invasive replacement and complex repair of the mitral valve through a right lateral minithoracotomy. However, morbidity and mortality associated with this novel technique were high.
Mohr
F W
FW
Department of Cardiac Surgery, Herzzentrum, Universität Leipzig, Germany.
Falk
V
V
Diegeler
A
A
Walther
T
T
van Son
J A
JA
Autschbach
R
R
D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods; D002315:Cardiopulmonary Bypass / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D008943:Mitral Valve / Q000601:surgery*; D011183:Postoperative Complications; D013908:Thoracotomy / Q000379:methods*; D014741:Video Recording