Mitral valve operation via Port Access versus median sternotomy

Abstract

Objective: The advantages and disadvantages of minimally invasive Port Access mitral valve operation have not been defined relative to standard median sternotomy. A study was therefore designed to delineate differences in outcome from mitral operation via Port Access versus sternotomy in comparable patients. Methods: The records of 41 consecutive patients undergoing isolated mitral valve replacement (n = 14) or repair (n = 27) were examined. All operations were performed using cardioplegic arrest through either median sternotomy (n = 20) or a small right anterolateral thoracotomy using an endoaortic clamp and catheter system (Heartport, Redwood City, CA) to arrest and decompress the heart (Port Access, n = 21). Results: Both groups were well matched for age, mitral pathology, ejection fraction, and comorbidity, except that Port Access patients were less likely to be female. Three patients had undergone previous cardiac operations. Surgical procedure time was longer for Port Access patients (384 ± 80 vs. 263 ± 41 min, P Ͻ 0.05). Port Access provided significantly smaller incision length (8 ± 2 vs. 26 ± 2 cm, P Ͻ 0.01) and similar or shorter hospital stay (6 ± 4 vs. 7 ± 3 days). Port Access provided excellent visualization of the mitral valve and subvalvular apparatus, generally better than sternotomy, to allow complex mitral valve repairs. The greatest advantage of Port Access mitral operation was that Port Access patients returned to normal activity more rapidly (4 ± 2 vs. 9 ± 1 weeks, P = 0.01) than did patients undergoing standard median sternotomy. Conclusions: By avoiding a sternotomy, Port Access mitral valve operation provided a smaller incision and a dramatically more rapid return to normal activity than did median sternotomy. Port Access cardioplegic arrest with the Heartport system allowed visualization of the mitral valve superior to median sternotomy and has become the standard approach at this institution.

Multivessel coronary bypass grafting with minimal access using cardiopulmonary bypass

“…These observations have also been reported in less invasive valve operations performed by the group at New York University (New York, NY) [11]. Glower [12] at Duke University (Durham, NC) reports that patient recovery with the small thoracotomy approach continues to progress more rapidly there as well.…”

Right Minithoracotomy Versus Median Sternotomy for Mitral Valve Surgery: A Propensity Matched Study

“…In these smaller randomized trials, adverse cardiac and cerebrovascular events as well as operative mortality were found to be comparable between the RT and MS groups [17][18][19]. In unmatched studies, RT also had advantages of earlier return to normal activity [20], less reoperation for bleeding [6], decreased pain [3], but increased risk of aortic dissection [5], while other unmatched studies found little effect of the RT approach on outcomes [21,22].…”

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

“…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 …”

“…When 22 patients who underwent reoperative mitral valve surgery via minithoracotomy after previous median sternotomy were interviewed, they all felt their recovery was more rapid and less painful than after their original sternotomy (32). Finally, one experienced center documented that patients return to normal activity five weeks earlier after thoracoscopy-assisted mitral valve surgery than after a median sternotomy (26). P r o c e d u r a l c o s t a n d r e s o u r c e u t i l i z a t i o n a r e increasingly important factors in evaluating different treatments.…”