Eight-year experience with minimally invasive cardiothoracic surgery.
BACKGROUND
Over the past decade, minimally invasive cardiac surgery (MICS) has emerged as an accepted approach for the management of cardiac disease that requires a surgical solution. We report the results of an 8-year, single-institution experience with MICS.


METHODS
Between January 1, 2000 and December 31, 2007, a total of 910 patients underwent MICS. Major cases included aortic valve procedures (71, 7.8%), coronary artery bypass grafting (96, 10.5%), atrioseptal defect repair (103, 11.3%), and mitral valve procedures (507, 55.7%). Major outcomes of interest included the complication and mortality rates.


RESULTS
The mean age of the patients was 57 +/- 15 years; the mean ejection fraction was 55% +/- 11%; and the mean body mass index was 26.1 +/- 4.9. Overall, 782 cases (85.9%) were performed through a mini-thoracotomy. Most of the cases were accomplished through central cannulation (765, 84.0%), and venous drainage was most commonly performed in a bicaval fashion (percutaneous superior vena cava and percutaneous inferior vena cava). The mean aortic cross-clamp and cardiopulmonary bypass (CPB) times were 58.1 +/- 44.9 and 101.9 +/- 66.8 min, respectively. Conversion to full sternotomy occurred in 10 patients, and the median length of stay in hospital was 6 days. The overall complication rate was 8.8%, and the 30-day mortality rate was 2.9%. In the multivariate logistic regression analysis, risk factors associated with in-hospital complications included age, CPB time, arterial cannulation location, conversion from off-CPB to on-CPB, hepatic insufficiency, and diabetes. In the multivariate hazards regression analysis, risk factors associated with mortality included postoperative stroke, renal failure, and sternal wound infection; CPB time; and previous surgery.


CONCLUSIONS
In our experience, minimally invasive approaches are effective and reproducible for a variety of cardiac operations, with acceptable operating time durations, morbidity, and mortality.
Division of Cardiothoracic Surgery, Department of Surgery, College of Physicians and Surgeons, Columbia University Medical Center, 77 Fort Washington Avenue, Milstein Hospital, Suite 7-435, New York, NY, 10032, USA. ai2141@columbia.edu
Alexander
A
Iribarne
Anna
A
Karpenko
Mark J
MJ
Russo
Faisal H
FH
Cheema
Faisal
F
Cheema
Tianna
T
Umann
Mehmet C
MC
Oz
Craig R
CR
Smith
Michael
M
Argenziano
D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D002318:Cardiovascular Diseases / Q000401:mortality / Q000601:surgery*; D013504:Cardiovascular Surgical Procedures / Q000379:methods* / Q000401:mortality; D015897:Comorbidity; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods* / Q000401:mortality; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000401:mortality; D016016:Proportional Hazards Models; D019616:Thoracic Surgical Procedures / Q000379:methods* / Q000401:mortality; D013908:Thoracotomy / Q000379:methods