Left sided heartport approach for combined mitral valve and coronary bypass surgery

BACKGROUND: To explore the possibility of achieving adequate exposure of th e mitral valve (MV) and the entire coronary anatomy using a limited (Port-A ccess) left lateral thoracotomy incision. METHODS: Using this incision, four patients underwent a single bypass to th e left anterior descending, combined with MV repair (1), MV replacement (2) , and left atrial (LA) myxoma excision (1). This approach required single l ung ventilation, femoral venous cannulation, and cannulation of the femoral artery or thoracic aorta. Exposure of the MV was achieved through a LA inc ision parallel to the atrio-ventricular groove, extending into the pulmonar y vein or behind the pulmonary artery as necessary. RESULTS: Excellent exposure of the MV and coronary anatomy was achieved in all patients. There were no surgical complications and all were discharged home within one week. CONCLUSION: Left-sided Port-Access is a valid technique particularly suitab le for combined primary MV and coronary bypass surgery. It does not allow e xposure of the tricuspid or aortic valve, however, and is not recommended i n repeat MV surgery due to the fragility of the LA appendage in such cases.