title: Minimally invasive port access versus conventional mitral valve surgery: prospective randomized study.
abstract: BACKGROUND
  We compared the port access mitral valve surgery with the conventional procedure through median sternotomy in a prospective randomized study.
  
  
  METHODS
  Forty elective patients with mitral valve disease were prospectively randomized to undergo minimally invasive (group I) or conventional (group II) mitral valve operation. The patients of group I had limited access through right small anterior thoracotomy and a femorofemoral cardiopulmonary bypass system using the endoclamp technique. To assess the efficiency and safety of the procedure, intraoperative and postoperative clinical data and markers of myocardial, cerebral, and lower limb ischemia were collected. Pulmonary function tests were performed to compare the preservation of pulmonary function. Neuropsychological tests were conducted for quantification of neurological and cognitive disorders.
  
  
  RESULTS
  Mitral valve reconstructions were performed in 28 patients (70%) in both groups. Intraoperative procedure-associated problems were experienced in 9 patients (45%) in group I, and 6 of them (30%) had to be converted to direct transthoracic aortic clamping. Markers of myocardial and cerebral damage as well as pulmonary and neuropsychological tests did not show statistically significant difference between groups.
  
  
  CONCLUSIONS
  The minimally invasive port access technique for mitral valve surgery can be done with similar clinical safety as procedures through median sternotomy. The problems with endoclamping have forced us to change our practice to the more simple and economic transthoracic aortic clamping technique.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt am Main, Germany. s.dogan@em.uni-frankfurt.de
authors.forename: Selami
authors.initials: S
authors.lastname: Dogan
authors.forename: Tayfun
authors.initials: T
authors.lastname: Aybek
authors.forename: Petar S
authors.initials: PS
authors.lastname: Risteski
authors.forename: Farooq
authors.initials: F
authors.lastname: Detho
authors.forename: Andrea
authors.initials: A
authors.lastname: Rapp
authors.forename: Gerhard
authors.initials: G
authors.lastname: Wimmer-Greinecker
authors.forename: Anton
authors.initials: A
authors.lastname: Moritz
mesh_terms: D002315:Cardiopulmonary Bypass; D002408:Catheters, Indwelling; D003402:Creatine Kinase / Q000097:blood; D052279:Creatine Kinase, MB Form; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000097:blood; D007527:Isoenzymes / Q000097:blood; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000601:surgery*; D016343:Monitoring, Intraoperative; D009211:Myoglobin / Q000097:blood; D009414:Nerve Growth Factors / Q000097:blood; D010751:Phosphopyruvate Hydratase / Q000097:blood; D011446:Prospective Studies; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins / Q000097:blood; D013249:Sternum / Q000601:surgery*; D013908:Thoracotomy; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood
chemical_list: D007527:Isoenzymes; D009211:Myoglobin; D009414:Nerve Growth Factors; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins; D020107:Troponin T; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form; D010751:Phosphopyruvate Hydratase