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J Thorac Cardiovasc Surg 1997;114:773-782
© 1997 Mosby, Inc.

SURGERY FOR ACQUIRED HEART DISEASE

VIDEO-ASSISTED MINIMALLY INVASIVE MITRAL VALVE SURGERY

Received for publication April 30, 1997 revisions requested May 21, 1997; revisions received June 16, 1997 accepted for publication June 18, 1997. Address for reprints: W. Randolph Chitwood, Jr., MD, Department of Surgery, East Carolina University School of Medicine, Greenville, NC 27858.

Abstract

Objective: This study was done to determine the potential benefits of minimally invasive mitral surgery performed with intraoperative video assistance. Methods: From May 1996 until March 1997, a minithoracotomy and video assistance were used in 31 consecutive patients undergoing mitral repair (n = 20) and replacement (n = 11). Their ages ranged from 18 to 77 years (59 ± 2.6 years; mean ± standard error of the mean). Ejection fractions were 35% to 62% (55% ± 1.5%). Operations were done with either antegrade/retrograde (n = 10) or antegrade (n = 19) cold blood cardioplegia and a new transthoracic crossclamp or with ventricular fibrillation (n = 2). Peripheral arterial cannulation (n = 28) and pump-assisted right atrial drainage (n = 26) were used most often. Results: No hospital deaths occurred, but the 30-day mortality was 3.2%. Complications included deep venous thrombosis and a phrenic nerve palsy in one patient each. No patient had a stroke or required reoperation for bleeding. Postoperative echocardiography showed excellent valve function in all but one patient. Cardiopulmonary bypass and arrest times averaged 183 ± 7.2 and 136 ± 5.5 minutes, respectively. Compared with 100 patients having conventional mitral valve operations, these patients had significantly shorter hospitalization times (8.6 ± 0.5 vs 5.1 ± 0.9 days, p = 0.05). Moreover, 81% of the later cohort were discharged between day 3 and 5 (3.6 ± 0.2 days). Hospital charges(27%, p = 0.05) and costs (34%, p < 0.05) were less than in conventional operations. Patient follow-up suggested minimal perioperative pain and rapid recovery. Conclusions: Early results suggest that video-assisted minimally invasive mitral operations can be done safely. These methods may benefit patients through less morbidity, earlier discharge, and l ower cost.

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