T. Aybek et al., The micro-mitral operation comparing the port-access technique and the transthoracic clamp technique, J CARDIAC S, 15(1), 2000, pp. 76-81
Background: Several minimally invasive approaches to the mitral valve have
been described, including parasternal incision and right anterolateral thor
acotomy. Material and Methods: Since September 1996, 58 patients underwent
minimally invasive mitral valve surgery at our institution through a right
anterolateral minithoractomy. Two different techniques were used for instit
ution of cardiopulmonary bypass (CPB) and aortic clamping: in the Port-Acce
ss group (group A) patients had femoro-femoral cannulation with a special a
rterial cannula to introduce an endoaortic balloon clamp (n = 23). The seco
nd group (group B) of patients underwent femoro-femoral CPB as well in comb
ination with a specially designed transthoracic aortic clamp (Chitwood tech
nique, n = 35). Patients were assigned to either technique in a nonrandomiz
ed fashion. Demographics were similar in both groups. Results: In group A,
4 valves were replaced, 19 patients had mitral valve repair. In group B, 7
patients had valve replacement and 28 patients underwent mitral repair. Fou
r patients in group A were converted to Chitwood technique due to endoclamp
dysfunction. Operating time, CPB time, cross-clamp time, and postoperative
blood loss were lower in group B (operating time 295 +/- 83 min vs. 236 +/
- 63.9 min; CPB min 167.6 = 64.9 min vs. 137.6 +/- 38.2 min; cross-clamp ti
me 105.9 +/- 51.7 min vs. 78.9 +/- 25.2 min; postoperative blood loss 584 /- 428 mt vs. 323 +/- 209 mL [p < 0.05]). Clinical outcome regarding postop
erative mechanical ventilatilation time, hospital stay and hospital mortali
ty was not different between groups. Conclusions: Minimally invasive mitral
valve procedures via right anterolateral minithoracotomy, including comple
x valve repair, can be performed successfully using either technique. Howev
er, the Chitwood technique provides better intraoperative handling with sho
rter operation time and less postoperative blood loss. Additionally, costs
of a procedure are less using the Chitwood technique compared to the Port-A
ccess technique.