Minimally invasive video-assisted mitral valve surgery: From port-access towards a totally endoscopic procedure

Right thoracotomy is an alternative to mid-sternotomy for left atrium acces s. The Port-Access approach is an option that reduces the skin incision and obviates rib spreading. Patients and methods: From February 1997 until Nov ember 1999, 121 patients underwent mitral valve surgery through a right ant ero-lateral thoracotomy using the Heartport cardiopulmonary bypass (CPB) sy stem. Mean age was 60 years (31-84). Most patients had normal ejection frac tions and were in NYHA Class II or Ill. Seventy-five patients had valve rep air (62%) and 46 (38%) had valve replacement. Pathologies were myxoid (n = 80), rheumatic (n = 30), chronic endocarditis (n = 5), annular dilatation ( n = 3), sclerotic (n = 1), ingrowing myxoma (n = 1), and one closure of a p aravalvular leak. Results. Two patients had conversion to sternotomy for ao rtic dissection tone died) with the Endo-Aortic Clamp, and two others for p eripheral vascular problems. One patient died at postoperative day 1 after reoperation for failed repair, another with double valve surgery on postope rative day 4 after two revisions for bleeding. Twelve underwent revision fo r bleeding (10%). Three had prolonged ICU stay for respiratory insufficienc y. Two late valve replacements for endocarditis occurred. Echographic contr ol revealed residual insufficiencies (grade 1-2) in two valvular repairs. T here were neither paravalvular leaks nor myocardial infarcts. There were no cerebrovascular accidents due to embolic phenomena. Mean ICU and hospital stay were 2.1 and 8.7 days, with a major difference between the first 30 pa tients and those who followed. Conclusion: Port-Access mitral valve surgery can be a valid alternative to conventional sternotomy and seems to be an i mportant improvement in minimally invasive cardiac surgery.