Minimally invasive video-assisted mitral valve surgery: Our lessons after a 4-year experience

Background. Right thoracotomy is a well known alternative to median sternot omy to gain access to the left atrium. To avoid the potential drawbacks ass ociated with sternotomy coupled to the desire for a smaller scar and a more rapid rehabilitation in young and active patients, we investigated the pur ported advantages in patients undergoing video-assisted Port-Access mitral valve surgery. Methods. Between February 1997 and November 2000, 175 patients (94 men, 81 women) with a mean age of 60 years (range 25 to 84) underwent either Port-A ccess mitral valve repair (n = 117) or replacement (n = 57) for degenerativ e disease (n = 112), rheumatic disease (n = 36), chronic endocarditis (n = 15), annular dilatation (n = 8), sclerotic disease (n = 2), and ingrowing m yxoma (n = 1). There was one closure of a preexisting paravalvular leak. St andard Carpentier-Edwards repair procedures were used in all patients; in 1 4 patients polytetrafluoroethylene chordae were inserted for anterior leafl et prolapse. A total of 74 patients (42%) were in New York Heart Associatio n functional class III/IV. Results. Hospital mortality was 1.1% (n = 2). Four patients had conversion to sternotomy and conventional extra corporeal circulation for repair of a dissected aorta (n = 2) or the inabilty to proceed to a safe femoral cannul ation (n = 2). Sixteen patients (9%) underwent a revision for bleeding. Mea n cross-clamp time and perfusion time was 95 minutes (range 24 to 160) and 135 minutes (range 75 to 215) respectively. Mean intensive care unit and to tal hospital stay was 1.8 days (1 to 30) and 8.7 days (4 to 36), respective ly. Three patients experienced late acute endocarditis: 2 had late mitral v alve replacements and 1 patient had medical therapy for late prosthetic val ve endocarditis. There were no myocardial infarctions, cerebrovascular even ts or peripheral ischemia due to thromboembolic phenomena. No wound complic ations were observed. The degree of patient satisfaction was very high. Conclusions. The video-assisted Port-Access mitral valve approach is a vali d alternative to sternotomy, with the same standards of results and quality . (C) 2001 by The Society of Thoracic Surgeons.