title: Quality of mitral valve repair: median sternotomy versus port-access approach.
abstract: OBJECTIVE
  We sought to compare early and late clinical and echocardiographic outcomes of patients undergoing minimally invasive mitral valve repair by means of the port-access and median sternotomy approaches.
  
  
  METHODS
  Between 2000 and 2009, 503 patients had mitral valve repair, of whom 143 underwent surgical intervention for isolated posterior leaflet pathology: 61 through port access and 82 through median sternotomy. The port-access group had better preoperative New York Heart Association functional class (P = .007) and a higher rate of elective cases (97% vs 87%, P = .037). Other preoperative characteristics were similar between the groups, including mitral valve pathology and repair techniques.
  
  
  RESULTS
  Operative, bypass, and clamp times were significantly longer in the port-access group. Mean hospital stay was 5.3 +/- 2.5 days in the port-access group versus 5.7 +/- 2.5 days in the median sternotomy group (P = .4). Early postoperative echocardiographic analysis showed that most patients in both groups had none or trivial mitral regurgitation and none of the patients had greater than grade 2 mitral regurgitation. Follow-up extended for up to 100 months (mean, 34 +/- 24 months). New York Heart Association class improved in both groups (P = .394). Freedom from reoperation was 97% and 95% in the port-access and median sternotomy groups, respectively. Late echocardiographic analysis revealed that 82% (49/60) in the port-access group and 91% (73/80) in the median sternotomy group were free from moderate or severe mitral regurgitation (P = .11).
  
  
  CONCLUSIONS
  In isolated posterior mitral valve pathology, quality of mitral valve repair with the port-access approach can compare with that with the conventional median sternotomy approach.
authors.affiliation: Department of Cardiac Surgery, Chaim Sheba Medical Center, Tel Hashomer, Israel. ehud.raanani@sheba.health.gov.il
authors.forename: Ehud
authors.initials: E
authors.lastname: Raanani
authors.forename: Dan
authors.initials: D
authors.lastname: Spiegelstein
authors.forename: Leonid
authors.initials: L
authors.lastname: Sternik
authors.forename: Sergey
authors.initials: S
authors.lastname: Preisman
authors.forename: Yaron
authors.initials: Y
authors.lastname: Moshkovitz
authors.forename: Aram K
authors.initials: AK
authors.lastname: Smolinsky
authors.forename: Amihai
authors.initials: A
authors.lastname: Shinfeld
mesh_terms: D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D016009:Chi-Square Distribution; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000209:etiology; D011787:Quality of Health Care; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D056346:Sternotomy / Q000009:adverse effects / Q000401:mortality; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography