Port-access cardiac surgery: clinical experience with first 50 cases.
BACKGROUND
Minimally invasive cardiac surgery constitutes an expanding field for the treatment of many cardiac diseases. We analyze our experience with the first 50 patients operated upon using the port-access system.


METHODS
From October 1999 to October 2000, 50 patients underwent cardiac operations with the port-access technique, for the correction of mitral and tricuspid disease, atrial septal defect closure, and removal of cardiac tumors. The mean age was 56.5 years. In 23 patients the mitral valve was repaired, in 14 cases a prosthetic replacement was performed, in 2 patients a paravalvular leak was resutured, 1 patient had a cardiac myxoma removed, and 1 patient had a correction of tricuspid regurgitation. In 9 cases an atrial septal defect closure was performed.


RESULTS
One redo patient, with severe tricuspid regurgitation, needed conversion to sternotomy; in all the other cases the results of surgery were good and there were no surgical limitations. The mean cross-clamping time and bypass time were 53 +/- 19 and 77 +/- 27 min respectively. The mean in-hospital stay was 6 days. Re-exploration for bleeding was required in 7 patients (14%). Three patients (6%) presented with a postoperative neurological lesion; 2 recovered completely within 48 hours whereas 1 patient had permanent hemiplegia at discharge. There was one hospital death (an 81-year-old patient died of multiorgan failure on the thirteenth postoperative day).


CONCLUSIONS
Minimally invasive port-access surgery is a reliable alternative to conventional surgery for the treatment of mitral and tricuspid disease, the removal of cardiac tumors, and the correction of atrial septal defects. It reduces trauma to the patient, provides a better cosmetic result and also allows for a faster recovery. Careful patient selection is important to avoid complications. Redo patients can be successfully treated and the risks of re-sternotomy avoided.
Citterio
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Cardiac Surgery Unit, Istituto Clinico Humanitas, Rozzano, MI, Italy. enrico.citterio@humanitas.it
Manasse
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Pilato
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Eusebio
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A
Bandera
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A
Gallotti
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R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001835:Body Weight / Q000502:physiology; D006328:Cardiac Catheterization / Q000379:methods; D006348:Cardiac Surgical Procedures / Q000379:methods; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000150:complications; D006349:Heart Valve Diseases / Q000150:complications; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology / Q000401:mortality; D007558:Italy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D008943:Mitral Valve / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000601:surgery