Optimally invasive mitral valve surgery: a safe and effective approach

Abstract

Methods Between April 2007 and December 2012, we used a sternum-sparing but optimally invasive approach to MV surgery on 99 patients (mean age 60.71 ± 12.9 years) with mean preoperative EF and LVEDD of 53.8 ± 11.4 % and 56.13 ± 6.9 mm, respectively. Twenty seven patients had previous coronary artery bypass and MV surgeries. All patients had severe mitral insufficiency (MI) from chordal rupture; prolapse of the anterior leaflet, paravalvular leak, endocarditis, floppy MV, and from previous MV surgery. The optimally invasive approach was a rightsided anterolateral thoracotomy at the 5th intercostal space with an approximately 10 cm skin incision. Cardiopulmonary bypass (CPB) was through either cannulation of the ascending aorta or femoral artery with direct bicaval cannulation. Modified Gerbode-Hetzer plication for ruptured chordae and modified Paneth-Hetzer posterior annulus shortening annuloplasty, for annulus dilatation or leaflet prolapse were employed. Paravalvular leaks were closed. Intraoperative TEE was used to evaluate the adequacy of repair or replacement.