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Video-assisted mitral surgery through a micro-access: a safe and reliable reality in the current era.
J Heart Valve Dis. 2008 Jan; 17(1):48-53.JH

Abstract

BACKGROUND AND AIM OF THE STUDY

Minimally invasive mitral valve surgery was introduced into clinical practice during the mid 1990s. The clinical benefits of the technique, namely a reduction of surgical trauma, increased patient comfort and shorter hospital stay, are achieved by using a video-assisted, minithoracotomy approach rather than a standard median sternotomy. Herein is described the authors' experience with video-assisted mitral surgery through a micro-access.

METHODS

Between September 2003 and September 2006, 100 patients (mean age 65.7 years; range: 16-84 years; 29 aged >75 years) underwent video-assisted port-access mitral valve surgery through a 4- to 6-cm anterior mini-thoracotomy. Mitral valve repair was carried out in 36 patients (36%) and mitral valve replacement (MVR) in 64 (64%) for degenerative (n = 54), rheumatic (n = 44), functional (n = 1) or infective disease (n = 1). Redo procedures were performed in 14 patients.

RESULTS

Peripheral extra-thoracic cardiopulmonary bypass (CPB) was used in all cases, and Endoclamp occlusion of the ascending aorta in 94%. The median intensive care unit and hospital stays were 20.0 +/- 30.8 h and 7.0 +/- 5.9 days, respectively. Hospital mortality was 4% (n = 4). No patient required conversion to sternotomy. Five patients (5%) underwent minimally invasive surgical revision for bleeding, and one patient (1%) had an early reoperation for MVR during the immediate postoperative course due to failure of a mitral valve repair. There were no perioperative myocardial infarctions, permanent strokes, major vascular complications, or peripheral ischemic events. Among the patients, 63% had no complications at all during the postoperative course, and no wound infections were observed.

CONCLUSION

Video-assisted mitral surgery through a micro-access may be performed safely, at low risk of morbidity and mortality, and with results and quality standards similar to those reported for a sternotomy approach. Of note, older patients may be successfully treated using this technique.

Authors+Show Affiliations

Department of Cardiovascular Surgery, Policlinica Gipuzkoa, San Sebastian, Spain. grik@eresmas.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

18365569

Citation

Greco, Ernesto, et al. "Video-assisted Mitral Surgery Through a Micro-access: a Safe and Reliable Reality in the Current Era." The Journal of Heart Valve Disease, vol. 17, no. 1, 2008, pp. 48-53.
Greco E, Zaballos JM, Alvarez L, et al. Video-assisted mitral surgery through a micro-access: a safe and reliable reality in the current era. J Heart Valve Dis. 2008;17(1):48-53.
Greco, E., Zaballos, J. M., Alvarez, L., Urso, S., Pulitani, I., Sàdaba, R., Juaristi, A., & Goiti, J. J. (2008). Video-assisted mitral surgery through a micro-access: a safe and reliable reality in the current era. The Journal of Heart Valve Disease, 17(1), 48-53.
Greco E, et al. Video-assisted Mitral Surgery Through a Micro-access: a Safe and Reliable Reality in the Current Era. J Heart Valve Dis. 2008;17(1):48-53. PubMed PMID: 18365569.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Video-assisted mitral surgery through a micro-access: a safe and reliable reality in the current era. AU - Greco,Ernesto, AU - Zaballos,Juan M, AU - Alvarez,Luis, AU - Urso,Stefano, AU - Pulitani,Ivana, AU - Sàdaba,Rafael, AU - Juaristi,Arantxa, AU - Goiti,Juan J, PY - 2008/3/28/pubmed PY - 2008/5/21/medline PY - 2008/3/28/entrez SP - 48 EP - 53 JF - The Journal of heart valve disease JO - J Heart Valve Dis VL - 17 IS - 1 N2 - BACKGROUND AND AIM OF THE STUDY: Minimally invasive mitral valve surgery was introduced into clinical practice during the mid 1990s. The clinical benefits of the technique, namely a reduction of surgical trauma, increased patient comfort and shorter hospital stay, are achieved by using a video-assisted, minithoracotomy approach rather than a standard median sternotomy. Herein is described the authors' experience with video-assisted mitral surgery through a micro-access. METHODS: Between September 2003 and September 2006, 100 patients (mean age 65.7 years; range: 16-84 years; 29 aged >75 years) underwent video-assisted port-access mitral valve surgery through a 4- to 6-cm anterior mini-thoracotomy. Mitral valve repair was carried out in 36 patients (36%) and mitral valve replacement (MVR) in 64 (64%) for degenerative (n = 54), rheumatic (n = 44), functional (n = 1) or infective disease (n = 1). Redo procedures were performed in 14 patients. RESULTS: Peripheral extra-thoracic cardiopulmonary bypass (CPB) was used in all cases, and Endoclamp occlusion of the ascending aorta in 94%. The median intensive care unit and hospital stays were 20.0 +/- 30.8 h and 7.0 +/- 5.9 days, respectively. Hospital mortality was 4% (n = 4). No patient required conversion to sternotomy. Five patients (5%) underwent minimally invasive surgical revision for bleeding, and one patient (1%) had an early reoperation for MVR during the immediate postoperative course due to failure of a mitral valve repair. There were no perioperative myocardial infarctions, permanent strokes, major vascular complications, or peripheral ischemic events. Among the patients, 63% had no complications at all during the postoperative course, and no wound infections were observed. CONCLUSION: Video-assisted mitral surgery through a micro-access may be performed safely, at low risk of morbidity and mortality, and with results and quality standards similar to those reported for a sternotomy approach. Of note, older patients may be successfully treated using this technique. SN - 0966-8519 UR - https://www.unboundmedicine.com/medline/citation/18365569/Video_assisted_mitral_surgery_through_a_micro_access:_a_safe_and_reliable_reality_in_the_current_era_ L2 - https://medlineplus.gov/heartvalvediseases.html DB - PRIME DP - Unbound Medicine ER -