title: Mitral surgery after prior cardiac operation: port-access versus sternotomy or thoracotomy.
abstract: BACKGROUND
  In reoperation for mitral valve disease, minimally invasive Port-Access (PORT) is a new alternative to standard median sternotomy (STER) or right thoracotomy (THOR); yet, the results of PORT in this setting have not been defined. The aim of this study was to evaluate the results of minimally invasive thoracotomy in reoperation for mitral valve disease.
  
  
  METHODS
  Retrospective results are reported for three consecutive series of patients undergoing reoperation for mitral disease using either PORT (n = 60, 1996 to 2001), THOR (n = 37, 1985 to 1997), or STER (n = 155, 1985 to 1997).
  
  
  RESULTS
  Red cell transfusion was 3 +/- 4, 14 +/- 13, and 12 +/- 12 units for PORT, THOR, and STER, respectively. Chest tube output was 352 +/- 361, 2048 +/- 3166, and 1683 +/- 3939 mL, respectively. Cardiopulmonary bypass times for these groups were 208 +/- 76 vs. 158 +/- 56 vs. 157 +/- 53 minutes. Thirty-day mortality was 0/60 (0%), 8/37 (22%), and 21/155 (14%), respectively.
  
  
  CONCLUSIONS
  This early clinical experience suggests that PORT is an acceptable alternative to THOR or STERN in reoperation for mitral valve disease, with potential advantages of avoiding redo sternotomy and reducing the surgical incision. However, these benefits may come at the expense of longer cardiopulmonary bypass times.
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
authors.forename: William R
authors.initials: WR
authors.lastname: Burfeind
authors.forename: Donald D
authors.initials: DD
authors.lastname: Glower
authors.forename: R Duane
authors.initials: RD
authors.lastname: Davis
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Landolfo
authors.forename: James E
authors.initials: JE
authors.lastname: Lowe
authors.forename: Walter G
authors.initials: WG
authors.lastname: Wolfe
mesh_terms: D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D013249:Sternum / Q000601:surgery*; D013906:Thoracoscopy; D013908:Thoracotomy; D013997:Time Factors