Minimally invasive versus sternotomy approaches for mitral reconstruction:Comparison of intermediate-term results

Background: This study compares intermediate-term outcomes of mitral valve reconstruction after either the standard sternotomy approach or the new min imally invasive approach. Although minimally invasive mitral valve operatio ns appear to offer certain advantages, such as reduced postoperative discom fort and decreased postoperative recovery time, the intermediate-term funct ional and echocardiographic efficacy has not yet been documented. Methods: From May 1996 to February 1999, 100 consecutive patients underwent primary mitral reconstruction through a minimally invasive right anterior thoracotomy and peripheral cardiopulmonary bypass and Port-Access technolog y (Heartport, Inc, Redwood City, Calif). Outcomes were compared with those for our previous 100 patients undergoing primary mitral repair who were ope rated on with the standard sternotomy approach. Results: Although patients were similar in age, the patients undergoing the minimally invasive approach had a lower preoperative New York Heart Associ ation classification (2.1 +/- 0.5 vs 2.6 +/- 0.6, P < .001). There was one (1.0%) hospital mortality with the sternotomy approach and no such case wit h the minimally invasive approach. Follow-up revealed that residual mitral insufficiency was similar between the minimally invasive and sternotomy app roaches (0.79 <plus/minus> 0.06 vs 0.77 +/- 0.06, P = .89, 0- to 3-point sc ale); likewise, the cumulative freedom from reoperation was not significant ly different (93.4% vs 96.8%, P = .38). Follow-up New York Heart Associatio n functional class was significantly better in the patients undergoing the minimally invasive approach (1.5 +/- 0.05 vs 1.2 +/- 0.05, P < .01). Conclusions:These findings demonstrate comparable 1-year follow-up results after minimally invasive mitral valve reconstruction. Both echocardiographi c results and New York Heart Association functional improvements were compa tible with results achieved with the standard sternotomy approach. The mini mally invasive approach for mitral valve reconstruction provides equally du rable results with marked advantages for the patient and should be more wid ely adopted.