Objective : In order to assess the benefit of minimally invasive valve procedures, we
reviewed our ministernotomy technique introduced since February 1997. Forty-four
operations were accomplished, including aortic valve replacement, mitral valve replacement
and repair, and double valve replacement. This technique was also used in 2 children for
ASD repair and an aortic valve reconstruction.
Results : The procedure was described by Gundry, via manubriotomy and partial upper
sternotomy. The skin-incision varied between 4 and 8 cm (mean 6.2 cm). We performed 35
aortic replacements, 4 mitral replacements and 4 repairs, and 1 double valve procedure. All
procedures were performed under transesophageal echocardiographic control. Cannulas
were introduced through the ministernotomy, avoiding femoral approach.
The mean age of the adult patients was 60.6 years (range 17-85). In 3 patients valve
replacement (2 mitral and 1 aortic) was performed due to severe endocarditis. The aortic
clamp time for aortic valve replacement was significantly higher in the M.I.V.T. group for
the first procedures compared to standard techniques (62 min vs. 53 min). De-airing and
volume load of the ventricles were most difficult to evaluate. Two patients were converted
to sternotomy due to bleeding problems or inaccessibility. Some patients were extubated
on the operation-table. Moreover the ICU-stay was reduced to less than one day for 21
patients. Hospital-stay was 9.4 days in average (range 5 - 42 days). We encountered 2
hospital deaths (1 decompensation and 1 endocarditis). No valvular dysfunction or
paravalvular leaks were demonstrated by echocardiography. Patients rapidly progressed
from a mean preoperative NYHA class 3 to a mean postoperative NYHA class 1.2.
Conclusion : The ministernotomy approach is a safe technique and became standard
procedure in our cardiac surgery department. Although the implantation is more
demanding, our patients took benefit of their minimally invasive technique by faster
mobilisation and revalidation.