Video-assisted mitral surgery through a micro-access: a safe and reliable reality in the current era.
OBJECTIVE
Minimally invasive mitral valve surgery was introduced into clinical practice during the mid 1990s. The clinical benefits of the technique, namely a reduction of surgical trauma, increased patient comfort and shorter hospital stay, are achieved by using a video-assisted, minithoracotomy approach rather than a standard median sternotomy. Herein is described the authors' experience with video-assisted mitral surgery through a micro-access.


METHODS
Between September 2003 and September 2006, 100 patients (mean age 65.7 years; range: 16-84 years; 29 aged >75 years) underwent video-assisted port-access mitral valve surgery through a 4- to 6-cm anterior mini-thoracotomy. Mitral valve repair was carried out in 36 patients (36%) and mitral valve replacement (MVR) in 64 (64%) for degenerative (n = 54), rheumatic (n = 44), functional (n = 1) or infective disease (n = 1). Redo procedures were performed in 14 patients.


RESULTS
Peripheral extra-thoracic cardiopulmonary bypass (CPB) was used in all cases, and Endoclamp occlusion of the ascending aorta in 94%. The median intensive care unit and hospital stays were 20.0 +/- 30.8 h and 7.0 +/- 5.9 days, respectively. Hospital mortality was 4% (n = 4). No patient required conversion to sternotomy. Five patients (5%) underwent minimally invasive surgical revision for bleeding, and one patient (1%) had an early reoperation for MVR during the immediate postoperative course due to failure of a mitral valve repair. There were no perioperative myocardial infarctions, permanent strokes, major vascular complications, or peripheral ischemic events. Among the patients, 63% had no complications at all during the postoperative course, and no wound infections were observed.


CONCLUSIONS
Video-assisted mitral surgery through a micro-access may be performed safely, at low risk of morbidity and mortality, and with results and quality standards similar to those reported for a sternotomy approach. Of note, older patients may be successfully treated using this technique.
Greco
Ernesto
E
Department of Cardiovascular Surgery, Policlinica Gipuzkoa, San Sebastian, Spain. grik@eresmas.com
Zaballos
Juan M
JM
Alvarez
Luis
L
Urso
Stefano
S
Pulitani
Ivana
I
Sàdaba
Rafael
R
Juaristi
Arantxa
A
Goiti
Juan J
JJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D016896:Treatment Outcome