title: [Introduction of Minimally Invasive Port-access Surgery for Aortic Valve Replacement;Yamagata University Hospital's Experience].
abstract: BACKGROUND
  Minimally invasive cardiac surgery (MICS) through a small intercostal thoracotomy has many advantages, but it is still challenging because of limited mobility through the small skin incision and surgical field. The benefits of MICS should be reached without compromising the quality of the operation and increasing the morbidity and mortality of standard sternotomy approach. We have recently introduced MICS-aortic valve replacement (AVR) in order to establish as a standard surgical technique for the treatment of aortic insufficiency.
  
  
  METHODS
  Eleven consecutive patients underwent MICS-AVR in Yamagata University Hospital. Anesthetic and surgical techniques were simplified and standardized as possible to overcome technical difficulties. Preoperative chest computed tomography( CT) provides useful information about suitability of the patient's anatomy for MICS approach. Furthermore, we developed a preoperative image overlay technique by projecting 3-dimensional CT image over the patient's body surface.
  
  
  RESULTS
  There was no operative death. MICS-AVR procedure was completed in 10 patients. One patient was converted to sternotomy approach probably because of the vascular spasm through femoral artery cannulation for extracorporeal circulation. Although there were some anxious points to manage MICS procedure, preoperative planning based on the image overlay from CT image were useful for setup and instrument placement for MICS.
  
  
  CONCLUSIONS
  MICS-AVR was introduced and safely performed with acceptable morbidity and excellent mortality at our institution. Close observation should be mandatory in order to implement individual and departmental performance monitoring with regard to the learning curves and surgical complications associated with less invasive procedure itself.
authors.affiliation: Second Department of Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan.
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Uchida
authors.forename: Azumi
authors.initials: A
authors.lastname: Hamasaki
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Kuroda
authors.forename: Masahiro
authors.initials: M
authors.lastname: Mizumoto
authors.forename: Atsushi
authors.initials: A
authors.lastname: Yamashita
authors.forename: Jun
authors.initials: J
authors.lastname: Hayashi
authors.forename: Seigo
authors.initials: S
authors.lastname: Gomi
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Sadahiro
authors.forename: Akihiro
authors.initials: A
authors.lastname: Abiko
authors.forename: Shunichi
authors.initials: S
authors.lastname: Kondo
mesh_terms: D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006785:Hospitals, University; D006801:Humans; D007564:Japan; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D011859:Radiography; D013908:Thoracotomy / Q000379:methods*; D016896:Treatment Outcome