TECHNIQUES AND RESULTS OF DIRECT-ACCESS MINIMALLY INVASIVE MITRAL-VALVE SURGERY - A PARADIGM FOR THE FUTURE

Objectives: Our objective was to determine whether direct-access minim ally invasive mitral valve surgery can improve recovery and cost while maintaining the efficacy of conventional surgery. Methods: Minimally invasive mitral valve operations were performed on 106 patients, 58% m ale, average age 58.1 years, with good ventricular function, Ninety un derwent repair of a regurgitant, myxomatous valve, and 16 underwent mi tral valvuloplasty for prematurely calcified mitral stenosis, The valv e was approached with standard instruments through a 5- to 8-cm right parasternal incision. Eighty-five had open femoral artery-femoral vein cannulation, but this technique has recently been replaced by direct cannulation of the aorta and percutaneous cannulation of the femoral v ein for most patients. Results: There were no operative deaths, The me an mitral regurgitation score (0-4) decreased from 3.7 to 0.7 after th e operation. Although ischemic and bypass times were increased, postop erative recovery was accelerated. Ventilatory support time, intensive care unit stay, hospital stay, need for rehabilitation, and return to ''normal activities'' all improved. Hospital charges, pain medications , and blood transfusions were also reduced. New atrial fibrillation co ntributed significantly to increased length of stay and charges, There were no deep wound infections. Other complications included re-explor ation for bleeding (n = 1), transient ischemic attacks (n = 2), stroke (n = 1), femoral artery injury (n = 5), pseudoaneurysm (n = 2), and a ntegrade dissection of the ascending aorta (n = 1). Two patients died and 1 required reoperation during a mean follow-up of 8.8 months. Conc lusions: Direct-access minimally invasive mitral valve surgery can acc elerate recovery, decrease charges, and decrease pain, while maintaini ng overall surgical efficacy. It has become our standard approach for isolated primary mitral valve operations.