title: Minimally invasive technology for mitral valve surgery via left thoracotomy: experience with forty cases.
abstract: BACKGROUND
  Recent evolution of minimally invasive technology has expanded the application of the right thoracotomy approach for mitral valve surgery. These same technological advances have also made the left posterior minithoracotomy approach attractive in complex mitral procedures.
  
  
  METHODS
  From 1996 to 2003, 921 isolated mitral valve procedures were performed without sternotomy; 40 (4.3%) of these were performed via left posterior minithoracotomy. In the left posterior minithoracotomy group, ages ranged from 18 to 84 years; 36 patients had had previous cardiac surgery (9 on > or =2 occasions). Other factors precluding right thoracotomy included mastectomy/radiation and pectus excavatum.
  
  
  RESULTS
  Arterial perfusion was via femoral artery (n = 26) or descending aorta (n = 14); long femoral venous cannulas with vacuum-assisted drainage were used in 39 procedures. Two patients had direct aortic crossclamping, 18 had hypothermic fibrillation, and 20 had balloon endoaortic occlusion. The mean crossclamp and bypass times were 81.9 and 117.2 minutes, respectively. Hospital mortality was 5.0% (2/40); both deaths occurred in octogenarians. There were no injuries to bypass grafts or conversions to sternotomy. Complications included perioperative stroke (2/40; 5.0%), bleeding (2/40; 5.0%), and respiratory failure (1/40; 2.5%); 28 patients (70%) had no postoperative complications. There was no incidence of perioperative myocardial infarction, renal failure, sepsis, or wound infection. The median length of stay was 7 days.
  
  
  CONCLUSIONS
  Advances in minimally invasive cardiac surgery technology are readily adaptable to a left-sided minithoracotomy approach to the mitral valve. The left posterior minithoracotomy approach is a valuable option in complicated reoperative mitral procedures with acceptable perioperative morbidity and mortality.
authors.affiliation: Department of Surgery, New York University School of Medicine, New York, NY 10016, USA.
authors.forename: Paul C
authors.initials: PC
authors.lastname: Saunders
authors.forename: Eugene A
authors.initials: EA
authors.lastname: Grossi
authors.forename: Ram
authors.initials: R
authors.lastname: Sharony
authors.forename: Charles F
authors.initials: CF
authors.lastname: Schwartz
authors.forename: Greg H
authors.initials: GH
authors.lastname: Ribakove
authors.forename: Alfred T
authors.initials: AT
authors.lastname: Culliford
authors.forename: Julie
authors.initials: J
authors.lastname: Delianides
authors.forename: F Gregory
authors.initials: FG
authors.lastname: Baumann
authors.forename: Aubrey C
authors.initials: AC
authors.lastname: Galloway
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Colvin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021721:Balloon Occlusion; D005263:Femoral Artery / Q000601:surgery; D005268:Femoral Vein / Q000601:surgery; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D008943:Mitral Valve / Q000473:pathology / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000401:mortality / Q000628:therapy; D008946:Mitral Valve Stenosis / Q000401:mortality / Q000628:therapy; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D011651:Pulmonary Artery / Q000601:surgery; D013908:Thoracotomy; D016896:Treatment Outcome