Minimally invasive mitral valve surgery: The subxiphoid approach

Background. This report describes mitral valve replacement using a unique s ubxiphoid approach with a lower ministernotomy and a skin crease incision a nd compares the operative and echocardiographic results to patients undergo ing mitral valve replacements using previously described strategies. Methods. Fifty-four patients underwent mitral valve replacement using a sub xiphoid approach (group 1); 32 patients underwent mitral valve replacement, 11 patients underwent mitral valve replacement + tricuspid reconstruction, 2 patients underwent mitral valve replacement + tricuspid valve replacemen t, and 9 patients underwent mitral reconstruction. This group of patients w as compared to 11 patients who underwent mitral valve replacement through a superior ministernotomy (group 2) and 29 patients who underwent mitral val ve replacement with full median sternotomy (group 3, 22 mitral valve replac ements, 2 mitral valve replacements + tricuspid reconstruction, 2 mitral re constructions, and 3 mitral reconstructions + tricuspid reconstruction). Results. There was no operative mortality in all groups. The operation last ed significantly longer in group 2 patients compared to group 1 and 3 patie nts (p < 0.01). Postoperative mediastinal drainage was significantly lower in groups 1 and 2 (p < 0.001). Pain assessment revealed no difference betwe en the groups. Three patients in group 1 presented with pericardial effusio n. Except for this complication, early postoperative echocardiographic find ings of the patients were similar in all three groups. All patients were in New York Heart Association functional class I or II at the second postoper ative month, irrespective of the surgical technique used. Conclusions. There was no prominent superiority of the ministernotomy appro aches over the standard median sternotomy approach. However the reliability of the subxiphoid approach is documented echocardiographically and any typ e of mitral replacement can be performed with this approach. (Ann Thorac Su rg 1999;67:1328-33) (C) 1999 by The Society of Thoracic Surgeons.