Minimally Invasive Port Access Versus Conventional Mitral Valve Surgery: Prospective Randomized Study

Is minimally invasive thoracoscopic surgery the new benchmark for treating mitral valve disease?

“…Reductions in postoperative bleeding and transfusion requirements after minimally invasive mitral valve surgery are likely due to smaller incisions and less extensive mediastinal dissection (5,7,8,(17)(18)(19)(20)(21)(22)(23). Other centers, including our own, have also demonstrated significant associations between less invasive mitral valve surgery and reduced bleeding and transfusion (7).…”

“…Therefore, thoracoscopic mitral valve surgery must be as safe, effective, and durable as the traditional "open" approach. To date, no comparison study has shown a significant difference in operative mortality when comparing minimally invasive mitral valve surgery to that through median sternotomy (4)(5)(6)(7)(8)(9)(10). Initial experiences with thoracoscopic mitral valve surgery documented mortality rates near 10% (11).…”

“…A number of studies, including meta-analyses, documented reductions in the duration of mechanical ventilation when minimally invasive approaches were utilized (8,10,12,13,19,20,25,26). Yet other experienced centers have not shown such a …”

“…benefit, including our own (7,8). Expedited extubation may result from enhanced preservation of mechanical chest wall functionality, or alternatively from different management protocols.…”

Aortic Stenosis: Geriatric Considerations

“…Aiming for smaller incision, without compromising the quality of the operation and the effectiveness of myocardial protection, improved early outcomes have been reached. We reported the safety and reliability of AVR via a partial upper sternotomy in 2003 (Dogan et al, 2003). In a prospective randomised trial, we showed that minimally invasive AVR can be performed with only slightly longer operative times, good cosmetic results and improved rib cage stability as well as significantly less blood loss.…”