Clinical experience with minimally invasive coronary artery and mitral valve surgery with the advantage of cardiopulmonary bypass and cardioplegic arrest using the port access technique

To minimize surgical trauma, the use of Port Access cardiac surgery was ini tiated in patients (pts) with coronary artery disease (CAD) (42 pts) or mit ral valve disease (MVD) (24 pts) in March 1996 at our institution. Altogeth er 42 pas (36 men, 6 women; age 31-75 years, median 59.0 years) with isolat ed lesions of the left anterior descending (LAD) artery underwent Port Acce ss coronary artery surgery (PACAS). A small (5-9 cm) incision was done para sternally on top on the fourth rib. The left internal mammary artery (LIMA) was dissected through the minithoracotomy or by using an additional thorac oscopic approach. A total of 24 pts (12 men, 12 women; age 30-75 years, med ian 62 years) underwent Port Access mitral valve surgery (PAMVS). In these pts the procedure Has performed through a small right thoracotomy (6-8 cm). In all cases, endovascular cardiopulmonary bypass (CPB) was instituted thr ough femoral cannulation, and an additional endoaortic balloon catheter was introduced into the ascending aorta for aortic occlusion. In pts with PACA S the survival was 98% (41/42) and in the PAMVS group 100%.. All pts but on e survived the PACAS and are well today. There were no deaths in the PAMVS group. The hospital stay was reduced by 1 day on average after PACAS and 3 days after PAMVS. Thus in well selected patients Port Access cardiac surger y represents a safe and feasible minimally invasive surgical approach that avoids the potential complications of a sternotomy while offering the advan tages and safety of CPB and cardioplegic arrest. This minimally invasive ap proach offers a shortened hospital stay and earlier rehabilitation.