VIDEO-ASSISTED MINIMALLY INVASIVE MITRAL-VALVE SURGERY

Objective: This study was done to determine the potential benefits of minimally invasive mitral surgery performed with intraoperative video assistance, Methods: From May 1996 until March 1997, a minithoracotomy and video assistance were used in 31 consecutive patients undergoing mitral repair (n = 20) and replacement (n = 11), Their ages ranged fro m 18 to 77 years (59 +/- 2.6 years; mean +/- standard error of the mea n), Ejection fractions were 35% to 62% (55% +/- 1.5%), Operations were done with either antegrade/retrograde (n = 10) or antegrade (n = 19) cold blood cardioplegia and a new transthoracic crossclamp or with ven tricular fibrillation (n = 2), Peripheral arterial cannulation (n = 28 ) and pump-assisted right atrial drainage (n = 26) were used most ofte n, Results: No hospital deaths occurred, but the 30-day mortality was 3.2%, Complications included deep venous thrombosis and a phrenic nerv e palsy in one patient each, No patient had a stroke or required reope ration for bleeding, Postoperative echocardiography showed excellent v alve function in all but one patient, Cardiopulmonary bypass and arres t times averaged 183 +/- 7.2 and 136 +/- 5.5 minutes, respectively, Co mpared with 100 patients having conventional mitral valve operations, these patients had significantly shorter hospitalization times (8.6 +/ - 0.5 vs 5.1 +/- 0.9 days, p = 0.05), Moreover, 81% of the later cohor t were discharged between day 3 and 5 (3.6 +/- 0.2 days), Hospital cha rges (down arrow 27%, p = 0.05) and costs (down arrow 34%, p < 0.05) w ere less than in conventional operations, Patient follow-up suggested minimal perioperative pain and rapid recovery, Conclusions: Early resu lts suggest that video-assisted minimally invasive mitral operations c an be done safely, These methods may benefit patients through less mor bidity, earlier discharge, and lower cost.