LESS INVASIVE TECHNIQUES FOR MITRAL-VALVE SURGERY

Objective: Minimally invasive surgical techniques aim at reducing the consequences of currently used large incisions, such as bleeding, pain , and risk of infection. Although this new approach developed rapidly in coronary surgery, it remains questionable in mitral valve surgery. This article reports the longest experience with minimally invasive mi tral valve surgery, with particular attention to approach and techniqu es, Methods: From February 1996, the date of the first case of minimal ly invasive mitral valve reconstruction, to April 1997, 22 patients wi th a mean age of 54 +/- 2.7 years were subjected to mitral valve surge ry performed with less invasive techniques. Exposure of the mitral val ve was achieved through a minithoracotomy (n = 12) or a ministernotomy (n = 10), Video assistance was used in all cases. Peripheral arterial cannulation (n = 21) and venous drainage (n = 22) were used in most c ases. Results: In this series, valve surgery consisted in 19 repairs, two replacements, and one closure of a periprosthetic leak. In two cas es it was necessary to convert to a larger incision. The average durat ion of cardiopulmonary bypass was 157 +/- 8.2 minutes, ventilatory ass istance 16 +/- 4.6 hours, and intensive care unit stay 2.1 +/- 0.4 day s, Two patients required reoperation for bleeding and another for earl y recurrence of mitral valve regurgitation, There were no deaths and a ll patients were discharged with normal valve function. At most recent follow-up, all patients were in functional class I, with resumption o f normal activity. Conclusion: Mitral valve surgery can be performed s afely by means of less invasive techniques, but with increased technic al difficulty. A low asymmetric median sternotomy seems preferable to an anterior thoracotomy.