MINIMALLY INVASIVE PORT-ACCESS MITRAL-VALVE SURGERY

Objectives: This study evaluates the feasibility of video-assisted min imally invasive mitral valve surgery by means of the Port-Access syste m, The aim of the study was to minimize surgical access and to develop a video-assisted surgical technique. Methods: The Port-Access system allows for closed chest endoluminal aortic clamping, cardioplegic arre st, and decompression of the heart, The mitral valve was either repair ed (n = 28) or replaced (n = 23) in 51 patients by means of a minimall y invasive approach through a right lateral minithoracotomy and under videoscopic guidance. Results: Mean length of incision was 5.4 +/- 1.8 cm (range 3.8 to 8 cm), Mean duration of operation, cardiopulmonary b ypass, and crossclamp time was 196 +/- 53, 133 +/- 52, and 72 +/- 27 m inutes, respectively. Median intubation time was 25.5 hours (range 5 t o 264 hours), Median duration of intensive care and hospital stay was 2 days (range 1 to 36 days) and 13 days (10 to 36 days), respectively, Hospital mortality was 9.8% (5/51). Overall morbidity was relatively high, In two patients acute retrograde aortic dissection led to conver sion of the procedure, At follow-up (261 +/- 13 days), three patients required reoperation for paravalvular leakage. Baseline mean Duke acti vity index score was 19.3 +/- 11.3 before the operation and increased to 23.2 +/- 10 at 6 weeks' and 24.2 +/- 10.3 at 12 weeks' follow-up, r espectively. Conclusion: The Port-Access system allows for video-assis ted minimally invasive replacement and complex repair of the mitral va lve through a right lateral minithoracotomy. However, morbidity and mo rtality associated with this novel technique were high.