Evaluation of two new heart valve surgery techniques: partial sternotomy and port-access approaches

Objectives: This review attempts to compare the port-access and partial ste rnotomy approaches of minimally invasive valve surgery. Methods: Our brief experiences of the two techniques are summarized with an attempt to compare safety, cost-effectiveness of the procedure and post discharge follow-up. One hundred and two patients undergoing the procedures between May 1996 and October 1998 were analyzed. There were 65 patients in the partial sternoto my (MN) group and 37 patients in the port-access (PAV) group. With the exce ption of a higher incidence of COPD in the MIV patients, there was no signi ficant difference in pre-operative variables between these two groups. Resu lts: Total operating room time, surgery time and cross-clamp time were sign ificantly increased in the PAV group. The operative mortality of patients w ith MIV was 3%(n = 2) while the PAV group was 8%(n = 3) (P = ns). More new atrial fibrillation was found in the MIV (26% versus 5%, P = 0.009). Otherw ise, there was no significant complications observed in either group. Durin g the 4-6 week follow-up, of those who were employed, 76% of MIV and 69% of PAV patients had returned to work. Of the retired patients more than 95% o f the patients in both groups had resumed their daily routine activity. Imp ortantly, the study showed PAV patients returned to work about 4 weeks soon er than MIV patients. Conclusions: MIV approach is more 'surgeon friendly' and can be carried out without increased intra-operative resource utilizati on. The PAV approach requires formal training and capital outlay for unique equipment, disposable and ancillary procedures. From a financial perspecti ve, if the PAV technique is to become widely accepted intra-operative effic iencies must be maximized, post-operative fast-tract protocol must be utili zed, financial expenditures for disposable equipment must decrease and requ irement of ancillary procedures must be reduced. (C) 1999 Elsevier Science B.V. All rights reserved.