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J Thorac Cardiovasc Surg 1998;115:567-571
© 1998 Mosby, Inc.

SURGERY FOR ACQUIRED HEART DISEASE

Minimally Invasive Port-Access Mitral Valve Surgery

From the Department of Cardiac Surgery, Herzzentrum, Universität Leipzig, Leipzig, Germany.

Read at the Seventy-seventh Annual Meeting of The American Association for Thoracic Surgery, Washington, D.C., May 4-7, 1997.

Received for publication May 5, 1997; revisions requested June 17, 1997; revisions received Oct. 20, 1997; accepted for publication Oct. 21, 1997. Address for reprints: F. W. Mohr, MD, PhD, Universität Leipzig, Herzzentrum, Klinik für Herzchirurgie, Russenstraße 19, D-04289, Leipzig, Germany.

Abstract

Objectives: This study evaluates the feasibility of video-assisted minimally invasive mitral valve surgery by means of the Port-Access system. The aim of the study was to minimize surgical access and to develop a video-assisted surgical technique.
Methods: The Port-Access system allows for closed chest endoluminal aortic clamping, cardioplegic arrest, and decompression of the heart. The mitral valve was either repaired (n = 28) or replaced (n = 23) in 51 patients by means of a minimally invasive approach through a right lateral minithoracotomy and under videoscopic guidance.
Results: Mean length of incision was 5.4 ± 1.8 cm (range 3.8 to 8 cm). Mean duration of operation, cardiopulmonary bypass, and crossclamp time was 196 ± 53, 133 ± 52, and 72 ± 27 minutes, respectively. Median intubation time was 25.5 hours (range 5 to 264 hours). Median duration of intensive care and hospital stay was 2 days (range 1 to 36 days) and 13 days (10 to 36 days), respectively. Hospital mortality was 9.8% (5/51). Overall morbidity was relatively high. In two patients acute retrograde aortic dissection led to conversion of the procedure. At follow-up (261 ± 13 days), three patients required reoperation for paravalvular leakage. Baseline mean Duke activity index score was 19.3 ± 11.3 before the operation and increased to 23.2 ± 10 at 6 weeks' and 24.2 ± 10.3 at 12 weeks' follow-up, respectively.
Conclusion: The Port-Access system allows for video-assisted minimally invasive replacement and complex repair of the mitral valve through a right lateral minithoracotomy. However, morbidity and mortality associated with this novel technique were high.

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