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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

F. W. Mohr, MD, PhD, V. Falk, MD, A. Diegeler, MD, T. Walther, MD, J. A. M. van Son, MD, PhD, R. Autschbach, MD, PhD, Hans G. Borst, MD

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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