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J Thorac Cardiovasc Surg 2001;121:708-713
© 2001 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

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

From the Divisions of Cardiothoracic Surgery and Cardiology, New York University School of Medicine, New York, NY.

Supported in part by The Foundation for Research in Cardiac Surgery and Cardiovascular Biology.

Received for publication May 16, 2000. Revisions requested July 6, 2000; revisions received Oct 24, 2000. Accepted for publication Oct 27, 2000. Address for reprints: Eugene A. Grossi, MD, New York University Medical Center, Suite 9-V, 530 First Ave, New York, NY 10028 (E-mail: grossi{at}cv.med.nyu.edu).

Abstract

Background: This study compares intermediate-term outcomes of mitral valve reconstruction after either the standard sternotomy approach or the new minimally invasive approach. Although minimally invasive mitral valve operations appear to offer certain advantages, such as reduced postoperative discomfort and decreased postoperative recovery time, the intermediate-term functional 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 technology (Heartport, Inc, Redwood City, Calif). Outcomes were compared with those for our previous 100 patients undergoing primary mitral repair who were operated 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 Association 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 with the minimally invasive approach. Follow-up revealed that residual mitral insufficiency was similar between the minimally invasive and sternotomy approaches (0.79 ± 0.06 vs 0.77 ± 0.06, P = .89, 0- to 3-point scale); likewise, the cumulative freedom from reoperation was not significantly different (94.4% vs 96.8%, P = .38). Follow-up New York Heart Association 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 echocardiographic results and New York Heart Association functional improvements were compatible with results achieved with the standard sternotomy approach. The minimally invasive approach for mitral valve reconstruction provides equally durable results with marked advantages for the patient and should be more widely adopted.

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