Mitral valve surgery via a right anterior mini-thoracotomy with central aortic cannulation and no endoscopic assistance

Abstract

Background: A variety of techniques have been described to reduce surgical access in mitral valve surgery: Mini-sternotomy (Gundry) involves partial division of the sternum while the right anterior mini-thoracotomy approaches described involve either Port Accesstradmark; (Heartport, Redwood City, CA), indirect endoscopic techniques (Chitwood) and more recently, robotic techniques (Intuitive Surgicaltradmark;). This report describes a simplified approach that "borrows" aspects from several techniques.

Methods: Using currently available technology, a simplified technique to perform mitral valve surgery (MVST) has been developed. MVST eliminates the need for endoscopic assistance and femoral arterial cannulation. The results of 50 of these patients were analyzed and compared with those of 66 patients who had isolated mitral valve surgery via a conventional approach (MVCS) over the same five-year interval.

Results: Between January 1, 1995 and December 31, 2000, 50 patients had mitral valve surgery performed with a simplified technique (MVST). Twenty-six (52%) of the MVST patients underwent mitral valve replacement and 24 (48%) underwent mitral valve repair. There were no in-hospital deaths in the MVST group, compared to a death rate of 7.1% in the MVCS group. There were no strokes and no perioperative myocardial infarctions in the MVST group. Average ICU stay was 3.4 days (1 day shorter than the MVCS group) and average hospital stay was 8.1 days, which was significantly less than the 12.5 day length of stay for the patients having MVCS (p<0.01). Blood was utilized in 36% of the MVST patients, compared to a 55% rate in the MVCS group. There were no wound infections in the MVST group. Two patients did develop bloody effusions requiring thoracentesis. Antegrade blood cardioplegia was used in 35 (70%) of the MVST patients. Antegrade and retrograde blood cardioplegia was used in 15 (30%) patients. Average cross-clamp time in the MVST group was 70 minutes compared to 85 in the MVCS group (p<0.05) and the average pump run was 98 minutes in the MVST group compared to 112 for the MVCS group (p=0.08).

Conclusion: Mitral valve surgery using a simplified, less invasive technique can be successfully and safely performed in selected patients, resulting in less blood utilization and shorter hospital length of stay, with a cosmetic result that rivals that of robotically assisted techniques.