Minimally invasive technology for mitral valve surgery via left thoracotomy: Experience with forty cases

Paul C. Saunders, Eugene A. Grossi*, Ram Sharony, Charles F. Schwartz, Greg H. Ribakove, Alfred T. Culliford, Julie Delianides, F. Gregory Baumann, Aubrey C. Galloway, Stephen B. Colvin, James Fann

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Recent evolution of minimally invasive technology has expanded the application of the right thoracotomy approach for mitral valve surgery. These same technological advances have also made the left posterior minithoracotomy approach attractive in complex mitral procedures. Methods: From 1996 to 2003, 921 isolated mitral valve procedures were performed without sternotomy; 40 (4.3%) of these were performed via left posterior minithoracotomy. In the left posterior minithoracotomy group, ages ranged from 18 to 84 years; 36 patients had had previous cardiac surgery (9 on ≥2 occasions). Other factors precluding right thoracotomy included mastectomy/radiation and pectus excavatum. Results: Arterial perfusion was via femoral artery (n = 26) or descending aorta (n = 14); long femoral venous cannulas with vacuum-assisted drainage were used in 39 procedures. Two patients had direct aortic crossclamping, 18 had hypothermic fibrillation, and 20 had balloon endoaortic occlusion. The mean crossclamp and bypass times were 81.9 and 117.2 minutes, respectively. Hospital mortality was 5.0% (2/40); both deaths occurred in octogenarians. There were no injuries to bypass grafts or conversions to sternotomy. Complications included perioperative stroke (2/40; 5.0%), bleeding (2/40; 5.0%), and respiratory failure (1/40; 2.5%); 28 patients (70%) had no postoperative complications. There was no incidence of perioperative myocardial infarction, renal failure, sepsis, or wound infection. The median length of stay was 7 days. Conclusions: Advances in minimally invasive cardiac surgery technology are readily adaptable to a left-sided minithoracotomy approach to the mitral valve. The left posterior minithoracotomy approach is a valuable option in complicated reoperative mitral procedures with acceptable perioperative morbidity and mortality.

Original languageEnglish
Pages (from-to)1026-1032
Number of pages7
JournalJournal of Thoracic and Cardiovascular Surgery
Volume127
Issue number4
DOIs
StatePublished - Apr 2004
Externally publishedYes

Funding

FundersFunder number
Foundation for Research in Cardiac Surgery and Cardiovascular Biology

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