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The Journal of Thoracic and Cardiovascular Surgery, Vol 116, 705-715, Copyright © 1998 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
NOTE: Fulltext is available only in pdf format
L Aklog, DH Adams, GS Couper, R Gobezie, S Sears and LH Cohn
OBJECTIVES: Our objective was to determine whether direct-access minimally
invasive mitral valve surgery can improve recovery and cost while
maintaining the efficacy of conventional surgery. METHODS: Minimally
invasive mitral valve operations were performed on 106 patients, 58% male,
average age 58.1 years, with good ventricular function. Ninety underwent
repair of a regurgitant, myxomatous valve, and 16 underwent mitral
valvuloplasty for prematurely calcified mitral stenosis. The valve was
approached with standard instruments through a 5- to 8-cm right parasternal
incision. Eighty-five had open femoral artery-femoral vein cannulation, but
this technique has recently been replaced by direct cannulation of the
aorta and percutaneous cannulation of the femoral vein for most patients.
RESULTS: There were no operative deaths. The mean mitral regurgitation
score (0-4) decreased from 3.7 to 0.7 after the operation. Although
ischemic and bypass times were increased, postoperative recovery was
accelerated. Ventilatory support time, intensive care unit stay, hospital
stay, need for rehabilitation, and return to "normal activities" all
improved. Hospital charges, pain medications, and blood transfusions were
also reduced. New atrial fibrillation contributed significantly to
increased length of stay and charges. There were no deep wound infections.
Other complications included re-exploration for bleeding (n = 1), transient
ischemic attacks (n = 2), stroke (n = 1), femoral artery injury (n = 5),
pseudoaneurysm (n = 2), and antegrade dissection of the ascending aorta (n
= 1). Two patients died and 1 required reoperation during a mean follow-up
of 8.8 months. CONCLUSIONS: Direct-access minimally invasive mitral valve
surgery can accelerate recovery, decrease charges, and decrease pain, while
maintaining overall surgical efficacy. It has become our standard approach
for isolated primary mitral valve operations.
ARTICLES
Techniques and results of direct-access minimally invasive mitral valve surgery: a paradigm for the future
Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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