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Ehud Raanani
Dan Spiegelstein
Leonid Sternik
Yaron Moshkovitz
Aram K. Smolinsky
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Right arrow Minimally invasive surgery

J Thorac Cardiovasc Surg 2010;140:86-90
© 2010 The American Association for Thoracic Surgery

Acquired Cardiovascular Disease

Quality of mitral valve repair: Median sternotomy versus port-access approach

Ehud Raanani, MD*, Dan Spiegelstein, MD, Leonid Sternik, MD, Sergey Preisman, MD, Yaron Moshkovitz, MD, Aram K. Smolinsky, MD, Amihai Shinfeld, MD

Department of Cardiac Surgery, Chaim Sheba Medical Center, Tel Hashomer, affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel

Received for publication July 13, 2009; revisions received September 2, 2009; accepted for publication September 17, 2009.

* Reprint requests: Ehud Raanani, MD, Department of Cardiac Surgery, Chaim Sheba Medical Center, Tel Hashomer, 52621, Israel. (Email: ehud.raanani{at}sheba.health.gov.il).

Objectives: We sought to compare early and late clinical and echocardiographic outcomes of patients undergoing minimally invasive mitral valve repair by means of the port-access and median sternotomy approaches.

Methods: Between 2000 and 2009, 503 patients had mitral valve repair, of whom 143 underwent surgical intervention for isolated posterior leaflet pathology: 61 through port access and 82 through median sternotomy. The port-access group had better preoperative New York Heart Association functional class (P = .007) and a higher rate of elective cases (97% vs 87%, P = .037). Other preoperative characteristics were similar between the groups, including mitral valve pathology and repair techniques.

Results: Operative, bypass, and clamp times were significantly longer in the port-access group. Mean hospital stay was 5.3 ± 2.5 days in the port-access group versus 5.7 ± 2.5 days in the median sternotomy group (P = .4). Early postoperative echocardiographic analysis showed that most patients in both groups had none or trivial mitral regurgitation and none of the patients had greater than grade 2 mitral regurgitation. Follow-up extended for up to 100 months (mean, 34 ± 24 months). New York Heart Association class improved in both groups (P = .394). Freedom from reoperation was 97% and 95% in the port-access and median sternotomy groups, respectively. Late echocardiographic analysis revealed that 82% (49/60) in the port-access group and 91% (73/80) in the median sternotomy group were free from moderate or severe mitral regurgitation (P = .11).

Conclusions: In isolated posterior mitral valve pathology, quality of mitral valve repair with the port-access approach can compare with that with the conventional median sternotomy approach.

Abbreviations and Acronyms MR = mitral regurgitation; MS = median sternotomy; MV = mitral valve; NYHA = New York Heart Association; PA = port access






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