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J Thorac Cardiovasc Surg 2008;136:1492-1495
© 2008 The American Association for Thoracic Surgery

Evolving Technology

Evaluation of a novel atrial retractor for exposure of the mitral valve in a porcine model

^a Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC
^b College of Veterinary Medicine, North Carolina State University, Raleigh, NC
^c Academic Hospital Maastricht, Maastricht, the Netherlands
^d Department of Statistics, North Carolina State University, Raleigh, NC

Received for publication June 21, 2008; revisions received August 8, 2008; accepted for publication August 18, 2008.

^_* Address for reprints: Guillaume Chanoit, DVM, MS, College of Veterinary Medicine, North Carolina State University, 4700 Hillsborough St, Raleigh, NC 27606. (Email: guillaume_chanoit{at}ncsu.edu).

Objectives: To describe a novel atrial retractor and compare 2 methods of intraoperative left atrial retraction for minimally invasive mitral valve repair.

Methods: Left atrial retraction was performed on 5 swine cadavers to evaluate performance (percent of mitral valve annulus accessible), complications encountered, ease of use, and surgical time for the minimally invasive atrial retractor and a HeartPort atrial retractor.

Results: Estimated accessibilities were 93.0% (standard error = 3.2) and 92.7% (standard error = 3.3) for the HeartPort and minimally invasive atrial retractor retractors, respectively, with a difference of 0.3% (standard error = 2.2%, P = .8832, df = 34). Tissue damage occurred in 1 case for the minimally invasive atrial retractor and 2 cases for the HeartPort retractor. The mean surgical times for retractor placement and mitral valve annulus exposure were 107.4 and 39.2 seconds for the HeartPort and minimally invasive atrial retractor retractors, respectively, with a difference of 68.2 seconds (P = .0092, df = 4).

Conclusions: The minimally invasive atrial retractor is a suitable alternative for atrial retraction compared with standard techniques of retraction. It provides comparable exposure of the mitral valve annulus, is less time consuming to place, provides subjectively more working volume within the left atrium, and has the advantage of minimal atriotomy incision length and customizable retraction.