Lower Ministernotomy Research Articles

Minimally-Invasive Mitral Valve Surgery

Minimally-invasive surgery is increasingly being utilised in patients with isolated valve disease who do not require concomitant coronary bypass. Minimally-invasive valve surgery has been performed at the Brigham and Women's Hospital, Harvard Medical School since July 1996 and has now been used in over 273 mitral valve operations, primarily valve repairs. The incisions used have evolved; we used a right para-sternal approach at first and have now changed to a lower mini-sternotomy. The operative techniques employed through this incision are identical to those used in a complete sternotomy. Operative mortality in our mitral valve series is zero. There have been five re-operations. The length of hospital stay and amount of blood utilised are both less than with a complete sternotomy. Most importantly, the patients' return to normality after complete recovery was quicker by approximately 2 weeks versus the conventional sternotomy. Minimally-invasive mitral valve surgery is a technique that can be utilised reproducibly for all techniques of repair or replacement.

Minimally invasive mitral valve surgery: the subxiphoid approach

Background. This report describes mitral valve replacement using a unique subxiphoid approach with a lower ministernotomy and a skin crease incision and compares the operative and echocardiographic results to patients undergoing mitral valve replacements using previously described strategies. Methods. Fifty-four patients underwent mitral valve replacement using a subxiphoid approach (group 1); 32 patients underwent mitral valve replacement, 11 patients underwent mitral valve replacement + tricuspid reconstruction, 2 patients underwent mitral valve replacement + tricuspid valve replacement, and 9 patients underwent mitral reconstruction. This group of patients was compared to 11 patients who underwent mitral valve replacement through a superior ministernotomy (group 2) and 29 patients who underwent mitral valve replacement with full median sternotomy (group 3, 22 mitral valve replacements, 2 mitral valve replacements + tricuspid reconstruction, 2 mitral reconstructions, and 3 mitral reconstructions + tricuspid reconstruction). Results. There was no operative mortality in all groups. The operation lasted significantly longer in group 2 patients compared to group 1 and 3 patients ( p < 0.01). Postoperative mediastinal drainage was significantly lower in groups 1 and 2 ( p < 0.001). Pain assessment revealed no difference between the groups. Three patients in group 1 presented with pericardial effusion. Except for this complication, early postoperative echocardiographic findings of the patients were similar in all three groups. All patients were in New York Heart Association functional class I or II at the second postoperative month, irrespective of the surgical technique used. Conclusions. There was no prominent superiority of the ministernotomy approaches over the standard median sternotomy approach. However, the reliability of the subxiphoid approach is documented echocardiographically and any type of mitral replacement can be performed with this approach.

Minimally invasive heart surgery. Executive Committee of the Council on Cardio-Thoracic and Vascular Surgery.

Limited access or minimally invasive coronary artery surgery is being evaluated in numerous North American medical centers. The purposes of this report are to (1) describe the techniques, (2) examine progress in this new field, (3) comment on the potential of these approaches, and (4) put into perspective the expected goals of minimally invasive coronary surgery, given the proven long-term results achieved with traditional techniques (sternotomy and cardiopulmonary bypass). Minimally invasive coronary artery bypass is performed using one of two approaches: (1) a series of small holes or “ports” in the chest (referred to as PACAB, PortCAB, or port-access coronary artery bypass) or (2) a combination of ports and a small incision directly over the coronary artery to be bypassed (referred to as MIDCAB or minimally invasive coronary artery bypass). As in standard coronary artery bypass graft surgery (CABG), anesthesia is required. PACAB is currently used only by investigators at a few university centers. In this method, cardiopulmonary bypass is performed using the femoral vessels. The heart is stopped and the bypasses are performed using instruments passed through the ports, with or without a small additional chest incision. As with abdominal laparoscopic surgery, the cardiac …