Minimally invasive mitral valve surgery--clinical experiences with a PortAccess system.

Abstract

This is the initial experience with a new minimally invasive surgical technique for the treatment of mitral valve disease using a PortAccess system. Between May 1996 and May 1997, 21 patients (nine male, 12 female, aged 30-75 years, median 64 years) underwent minimally invasive mitral valve surgery. The underlying diseases were: mitral valve insufficiency (n = 11), mitral valve stenosis (n = 5) and combined mitral valve disease (n = 5). Through a small right thoracotomy (6-8 cm) access to the pericardium and the heart was gained. Cardiopulmonary bypass was instituted through femoral cannulation and an intraaortic balloon-catheter (Heartport Inc., Redwood City, CA) was introduced for aortic occlusion, aortic root venting and delivery of cold crystalloid cardioplegia. Mitral valve repair (four patients) or replacement (15 patients) was performed. There was no death during the whole follow-up period. There was no perivalvular leak and only minor residual mitral valve regurgitation was observed on intraoperative or postoperative (3 months) transesophageal echocardiography. There was no postoperative study-related complication. Time of ventilation, intensive care unit and hospital-stay were comparable with the data of patients undergoing conventional mitral valve surgery. This technique of PortAccess mitral valve surgery combines the advantage of less invasive operative trauma with the safety of conventional mitral valve surgery.