The evolution of minimally invasive mitral valve surgery - 2 year experience

Objectives: The aim of the study was to evaluate the evolution of Port-Acce ss minimally invasive mitral valve surgery to a robot assisted video assist ed solo surgery approach. Methods: One hundred and twenty-nine patients wit h non-ischemic mitral valve disease underwent 3D-video assisted mitral valv e surgery via a 4 cm right lateral minithoracotomy using femoro-femoral byp ass and endoaortic clamping. Transcranial Doppler and continuous transesoph ageal echocardiography were used to monitor placement and positional stabil ity of the endoclamp. After the initial series (group I, n = 62), a simplif ied solo surgical technique using voice controlled robotic assistance for v ideoscope guidance was used in the last 67 patients (group II). Results: Af ter an initial learning curve and modifications of catheter design, the pro cedure could be steadily redefined and simplified. In the last 67 patients, the procedure was completed without the need for an additional assistant a s 'solo surgery'. The mitral valve was repaired in 72 and replaced in all o ther patients. Duration of bypass and clamp time steadily improved during o ur study and in the most recent 67 patients average 107 +/- 34 and 48 +/- 1 6 min, respectively. The voice controlled robotic arm (AESOP 3000, Automate d Endoscope System for Optimal Positioning) provided a stable and precise v ideo image with excellent exposure of all valvular and subvalvular structur es. Hospital mortality was high in the early series (mean survival 88.7% at 804 +/- 35 days; 95% CI: 735-873) and partially procedure related (aortic dissection in two patients). In group II, hospital mortality has declined t o 3.0% (mean survival 97.0% at 568 +/- 12 days; 95% CI: 553-600). Conclusio n: Port-Access minimally invasive mitral valve surgery has evolved to be a reliable video assisted technique with reproducible results. Surgery can no w be performed almost in the same time as with conventional techniques. Rob otic assistance has enabled a solo surgery approach. (C) 1999 Elsevier Scie nce B.V. All rights reserved.