The left atrial roof incision: an asset for minimally invasive mitral valve surgery.
BACKGROUND
The focus in minimally invasive mitral valve surgery has been on reducing thoracic incisions. Several cardiac incisions described in these procedures do not conform with the philosophy of "minimal invasiveness". We describe the left atrial roof incision which has the potential of facilitating an excellent mitral valve exposure through a limited cardiac incision, without major cardiac trauma. The safety, efficacy and technical ease of this technique for minimally invasive mitral valve surgery is evaluated.


METHODS
From July 1998 to December 2000, 95 consecutive patients underwent mitral valve surgery by the same surgeon. The patients were divided into 2 groups on the basis of the cardiac incision used for correction of mitral valve disease. Group I patients had left atrial roof incision and group II patients had the traditional paraseptal incision. Each group was further classified into the minimally invasive sternotomy and standard sternotomy subgroups. The clinical variables and complications in the 2 groups were compared.


RESULTS
There were 40 male and 55 female patients with a mean age of 63 +/-12yrs (range 29 to 88yrs). LARI was used for mitral valve exposure in 81 patients (85%). In 18 patients (19%), surgery was by minimally invasive technique. The mitral valve was replaced in 82% of patients and repaired in 18%. LARI provided a better exposure of the mitral valve in its anatomical and physiological disposition, without distortion. There was no significant difference in the cross clamp times and postoperative complications between the 2 groups. More patients in the LARI group regained sinus rhythm at discharge.


CONCLUSIONS
LARI is safe and technically easy to perform. It provides an excellent exposure of the mitral valve and left heart cavities in its anatomical disposition with minimal cardiac trauma, making it ideal for minimally invasive mitral surgery.
Ngaage
D L
DL
Department of Cardiothoracic Surgery, Yorkshire Heart Center, United Kingdom. dumbor@ngaage.freeserve.co.uk
Nair
U R
UR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006325:Heart Atria / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D013908:Thoracotomy / Q000379:methods*