title: Video and robotic-assisted minimally invasive mitral valve surgery: a comparison of the Port-Access and transthoracic clamp techniques.
abstract: BACKGROUND
  In order to assess different surgical techniques for video-assisted minimally invasive mitral valve surgery, a retrospective study was undertaken comparing the Port-Access system (Cardiovations, Ethicon Inc, Somerville, NJ) and the transthoracic clamp technique.
  
  
  METHODS
  In 120 patients mitral valve surgery was performed through a small right minithoracotomy using either the Port-Access endovascular cardiopulmonary bypass system (Port-Access, n = 60) or the transthoracic clamp technique (MICRO, n = 60). Mean patient age was 61.5 +/- 10.5 years (81 patients with isolated mitral valve insufficiency, 39 patients with combined mitral valve disease).
  
  
  RESULTS
  Eighty-one (67.5%) patients underwent mitral valve repair and 39 (32.5%) patients had valve replacement. Mean time of surgery was 4.5 +/- 3.5 and 4.1 +/- 3.2 hours (p = 0.07), aortic cross-clamp time 89 +/- 69 and 78 +/- 65 minutes (p = 0.08), mean intensive care unit stay 1.5 +/- 2.1 and 1.6 +/- 2.5 days (p = ns), and hospital stay 9.0 +/- 10.5 and 9.2 +/- 9.7 days (p = ns) in the Port-Access and MICRO groups, respectively. In the Port-Access group, there were 6 reexplorations for bleeding, one perforation of the right ventricle with the endopulmonary vent, and 2 reconstructions of the femoral artery necessary after femoral cannulation, compared to one reexploration for bleeding in the MICRO group. There was only one minor paravalvular leak after replacement and 2 cases of residual greater than or equal to grade II mitral valve regurgitation after mitral valve repair in the Port-Access group, necessitating reoperation. In both groups, there was no mortality, no cerebrovascular accident, no aortic dissection, and no conversion to sternotomy.
  
  
  CONCLUSIONS
  Minimally invasive mitral valve surgery has become a standard approach for isolated mitral valve operations at our institution. The MICRO technique tends to shorten the time of surgery and aortic cross-clamping and reduces perioperative costs by simplifying the operative procedure.
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Hermann
authors.initials: H
authors.lastname: Reichenspurner
authors.forename: Christian
authors.initials: C
authors.lastname: Detter
authors.forename: Tobias
authors.initials: T
authors.lastname: Deuse
authors.forename: Dieter H
authors.initials: DH
authors.lastname: Boehm
authors.forename: Hendrik
authors.initials: H
authors.lastname: Treede
authors.forename: Bruno
authors.initials: B
authors.lastname: Reichart
mesh_terms: D002315:Cardiopulmonary Bypass; D002408:Catheters, Indwelling; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods*; D015996:Survival Rate; D013908:Thoracotomy / Q000379:methods*; D016896:Treatment Outcome; D020535:Video-Assisted Surgery / Q000009:adverse effects / Q000379:methods*