CLINICAL-EXPERIENCES WITH MINIMALLY INVASIVE MITRAL-VALVE SURGERY USING A SIMPLIFIED PORT ACCESS(TM) TECHNIQUE

Objective: Using the initial experiences with the Port-Access(TM) tech nique for the treatment of mitral valve disease some changes were made thus resulting in more simple and faster procedures. Methods: Twenty- nine patients (13 male, 16 female, aged 30 to 75 years, median 62.5 +/ - 11.0 years) underwent minimally invasive mitral valve surgery betwee n May 1996 and December 1997. The underlying diseases were: mitral val ve insufficiency (n = 16), mitral valve stenosis (n = 7) and combined mitral valve disease (n = 6). Through a small right thoracotomy (5-7 c m) access to the pericardium and the heart was gained. Cardiopulmonary bypass was instituted through femoral cannulation and an intraaortic balloon-catheter was introduced for aortic occlusion, aortic root vent ing and delivery of cold crystalloid cardioplegia. Mitral valve repair (five patients) or replacement (24 patients) was performed. Results: There was no death during the whole follow-up period. There was no per ivalvular leak and only minor residual mitral valve regurgitation was observed on intraoperative or postoperative (3 months) transesophageal echocardiography in three patients. There was no postoperative study- related complication. Time of ventilation and intensive care unit were comparable with the data of patients undergoing conventional mitral v alve surgery but hospital stay was shorter in the last 10 consecutive cases. Conclusions: This simplified technique of mitral valve surgery combines the advantage of less invasive operative and good cosmetic re sults with the safety of conventional mitral valve surgery. At our ins titution this technique presents in well selected patients suffering f rom mitral valve disease the procedure of choice. (C) 1998 Elsevier Sc ience B.V. All rights reserved.