title: Minimally invasive mitral valve surgery through right anterolateral minithoracotomy.
abstract: BACKGROUND
  This study evaluates the feasibility of minimally invasive mitral valve surgery. The aim of the study was to minimize surgical access to achieve better cosmetic results, less postoperative discomfort, and faster recovery.
  
  
  METHODS
  From September 1997 to October 1998, 76 patients underwent mitral valve surgery through a right anterolateral minithoracotomy at the fourth intercostal space. The mitral valve was either repaired (n = 21) or replaced (n = 55). In all cases, open femoral artery-femoral vein cannulation was used for cardiopulmonary bypass. In 27 cases, an endoluminal aortic clamp was used, but in 49 cases, the aorta was cross-clamped with a transthoracic, sliding-rod-design clamp.
  
  
  RESULTS
  There were no approach-related limitations to surgical intervention. Intraoperative transesophageal echocardiography revealed excellent results after valve repair and no paravalvular leak in any patient after mitral valve replacement. Mean duration of intensive care and postoperative hospital stay was 32+/-5.2 hours and 7+/-1.1 days, respectively. There were no major complications related to femoral vessel cannulation. In 1 patient, transient neurological problems developed, with subsequent complete recovery. There was one hospital mortality (85-year-old male patient died of upper GI bleeding).
  
  
  CONCLUSIONS
  Minimally invasive port access mitral valve surgery can accelerate recovery and decrease pain, while maintaining overall surgical efficacy. It also provides better cosmetic results to our patients, and now it has become our standard approach for isolated mitral valve surgery.
authors.affiliation: Escorts Heart Institute and Research Centre, New Delhi, India. ehirc@vsnl.com
authors.forename: Y K
authors.initials: YK
authors.lastname: Mishra
authors.forename: R
authors.initials: R
authors.lastname: Malhotra
authors.forename: Y
authors.initials: Y
authors.lastname: Mehta
authors.forename: K K
authors.initials: KK
authors.lastname: Sharma
authors.forename: R R
authors.initials: RR
authors.lastname: Kasliwal
authors.forename: N
authors.initials: N
authors.lastname: Trehan
mesh_terms: D000328:Adult; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation; D002315:Cardiopulmonary Bypass / Q000295:instrumentation; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation*; D008943:Mitral Valve / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D013525:Surgical Instruments; D013908:Thoracotomy / Q000295:instrumentation*; D016896:Treatment Outcome