title: Two hundred forty minimally invasive mitral operations through right minithoracotomy.
abstract: BACKGROUND
  This study reports of our 7-year experience with minimally invasive mitral valve operations using the transthoracic clamp technique, reviewing morbidity and mortality as well as echocardiographic follow-up results.
  
  
  METHODS
  Between 1997 and 2004, 241 patients (121 male; aged 56 +/- 14 years) underwent minimally invasive mitral valve surgery through right thoracotomy using the transthoracic clamp technique. Reconstructions were done in 199 patients, and 42 valves were replaced. Mean length of incision was 7.0 +/- 1.2 cm. Mean preoperative New York Heart Association functional class was 2.6 +/- 0.9.
  
  
  RESULTS
  Thirty-day mortality was 3.3% (n = 8). Operating, bypass, and cross-clamp times averaged 241 +/- 52, 142 +/- 40, and 84 +/- 26 minutes, respectively. Seven patients (2.9%) had conversion to sternotomy. Nine patients (3.7%) underwent reexploration for bleeding. Mean intensive care unit and hospital stay were 18 hours and 8.1 days, respectively. Mean follow-up was 30 +/- 18 months (range, 3 to 76). Echocardiographic follow-up documented persistently competent valve function in all but 6 patients who had grade III regurgitation. Five of them underwent mitral valve re-reconstruction and 1 underwent transplantation. At 76 months, freedom from nontrivial recurrent mitral regurgitation and reoperation were 92.3% and 96.2%, respectively. Actuarial survival at 76 months, including early mortality, was 90.7%. Thoracic wounds were free from infection in all patients.
  
  
  CONCLUSIONS
  This study demonstrates that the direct vision, transthoracic clamp technique for minimally invasive mitral valve surgery is reproducible with low mortality and morbidity rates. It results in excellent cosmesis and abolished the risk of thoracic wound infection. Results are comparable to midterm outcomes of conventional operations.
authors.affiliation: Department for Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt/Main, Germany. tayfun@aybek.de
authors.forename: Tayfun
authors.initials: T
authors.lastname: Aybek
authors.forename: Selami
authors.initials: S
authors.lastname: Dogan
authors.forename: Petar S
authors.initials: PS
authors.lastname: Risteski
authors.forename: Andreas
authors.initials: A
authors.lastname: Zierer
authors.forename: Thomas
authors.initials: T
authors.lastname: Wittlinger
authors.forename: Gerhard
authors.initials: G
authors.lastname: Wimmer-Greinecker
authors.forename: Anton
authors.initials: A
authors.lastname: Moritz
mesh_terms: D000293:Adolescent; D000368:Aged; D000369:Aged, 80 and over; D003250:Constriction; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D008943:Mitral Valve / Q000601:surgery*; D012086:Reoperation; D013908:Thoracotomy / Q000379:methods*; D016896:Treatment Outcome