Paul Modi1, Evelio Rodriguez1, Karen A. Gersch1, Wilson Szeto2, W Clark Hargrove2, Walter Randolph Chitwood1.
1East Carolina Heart Institute, East Carolina University, Greenville, NC, USA, 2Presbyterian Medical Center, Philadelphia, PA, USA.
OBJECTIVE: Minimally invasive mitral valve surgery (MIMVS) has become the standard of care at many institutions. We reviewed the experience at two centers using video-assisted MIMVS through a right minithoracotomy .
METHODS: Retrospective chart review of all MIMVS from May 1996 to January 2006. Cardiopulmonary bypass (CPB) involved peripheral cannulation and vacuum-assisted venous drainage. Myocardial protection was achieved using 1) antegrade cardioplegia and transthoracic clamping (TTC), or 2) cold fibrillatory arrest, or 3) endoaortic balloon occlusion (EABO). Patient demographics, comorbidities, morbidity, mortality and operative failures were recorded. Statistical analysis using the Fisher's exact and Pearson's chi square tests were performed.
RESULTS: 890 patients underwent MV repair (n=706, 79%) or replacement (n=184, 21%). Previous cardiac surgery had been performed in 129 (14.5%). Mean age was 60.9±14 years. Comorbidities included atrial fibrillation (n=285, 32%), hypertension (n=377, 42.4%), coronary artery disease (n=134, 15.1%) and congestive cardiac failure (n=553, 62%). Concomitant procedures occurred in 217 (24.4%), including patent foramen ovale closure (n=43), left atrial appendage ligation (n=146), pulmonary vein isolation (n=109), CABG (n=4) and tricuspid repair (n-39). Thirty day mortality was 2.9% (n=26). Complications included 14 strokes (1.5%), 14 conversions to sternotomy (1.5%) and 47 re-explorations for bleeding (5.2%). Five aortic dissections occurred in the EABO group compared to 1 in the TTC group (p=0.11). Duration of intubation was 16±74 hours and length of hospital stay was 7.2 ±6 days. Mitral re-operation was required in 2.8%.
CONCLUSIONS: MIMVS alone or in combination with other cardiac procedures is safe and reproducible. EABO is associated with a higher incidence of aortic dissection although this was not statistically significant. Long-term follow-up studies are needed to ascertain the durability of MIMVS.
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