[Video-assisted cardiac valve surgery].
OBJECTIVE
Advances in the development of video-assisted systems for minimally invasive surgery now allow to perform cardiac surgery via a smaller anterolateral thoracotomy in order to reduce trauma, pain and improve cosmetics. In addition, due to sternal sparing, pulmonary function should improve resulting in reduced hospital stay and costs. However, only few centers worldwide abstain from spreading the ribs thus accepting considerable pain and reduced patient comfort. The minimally invasive approach described here uses a right-sided anterolateral incision (4-5 cm), a soft-tissue retractor and femorofemoral perfusion with endoclamping under continuous TEE (transesophageal echocardiography) control. It was the aim of this retrospective analysis to determine feasibility, safety and effectiveness of the method.


METHODS
At the West German Heart Center Essen, 47 patients were operated using minimally invasive endoscopic techniques between January 2004 and April 2006 on the mitral valve (n = 31), mitral and tricuspid valve (n = 9), including mini-Maze procedure in two cases, as well as atrial septal defects (n = 5) and myxomas (n = 2). Mean age was 58 +/- 15.2 years (range 29-87 years), NYHA II-III, 20 patients were male.


RESULTS
All but one patient survived (2.1%). Conversion to median sternotomy was necessary in three of the first twelve patients. After a mean follow-up period of 18 months all reconstructions and valves were competent, freedom from cardiac reoperation was 100%. On a visual analog scale 91% ot the patients reported no or mild postoperative pain, 96% felt they had an aesthetically pleasing scar. All but one patients would choose the same operation again.


CONCLUSIONS
Videoscopically assisted, endoscopic cardiac surgery can be performed safely, but requires a learning curve and intense training. After evaluation of efficacy and safety it is now the authors' exclusive approach to isolated atrioventricular valve disease with an ideal pain-free and cosmetic result.
Kamler
Markus
M
Abteilung für Thorax- und Kardiovaskuläre Chirurgie, Westdeutsches Herzzentrum Essen, Universitätsklinikum Essen, Essen.
Wendt
Daniel
D
Szabó
Andraz
A
Wiese
Ingo
I
Kottenberg-Assenmacher
Eva
E
Buck
Thomas
T
Jakob
Heinz
H
D000328:Adult; D000368:Aged; D004452:Echocardiography; D004869:Equipment Safety; D005260:Female; D005500:Follow-Up Studies; D006338:Heart Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation*; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery; D009232:Myxoma / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality; D012086:Reoperation / Q000706:statistics & numerical data; D013525:Surgical Instruments; D016019:Survival Analysis; D020775:Thoracic Surgery, Video-Assisted / Q000295:instrumentation*; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000601:surgery