In February 1997, Heartport obtained CE-Mark for its endoCPB and endoclamp technology
and appropriate surgical instruments for Port-Access surgery, an endoscopic technique that
permits the surgeon to perform surgery through a series of small intercostal ports.
This is the report of our initial experience to evaluate the outcome of patients with Port-
Access surgery in a variety of pathology.
From February 1997, 35 patients (13Males/22Females) had Port-Access surgery. Twenty-one
patients had mitral valve surgery for a variety of pathology: degenerative disease (10),
postendocarditis (3), rheumatic disease (6) and annular dilatation (2). One of these patients
had simultaneous annuloplasty and ASD closure. Seven patients had ASD closure only, one
patient had a removal of a left atrial myxoma and another patient underwent arteriolysis.
Finally, four patients with single vessel disease and one patient with double vessel underwent
sequential IMA bypass. The last patient had an additional venous bypass on the PDA. In all
cases, the LIMA was harvested through an intercostal port under video-assisted visualization.
One 61-year-old patient requiring mitral valve surgery, had conversion to sternotomy and
conventional ECC for acute dissection of the aorta. One patient had reopening of her
minithoracotomy for bleeding and one patient had thoracoscopic revision of the thoracic
cavity for haemothorax. There was no mortality.
A reasonable access to both the left and right atrial cavity is possible through a small intercostal
port. A mitral valve can be replaced. Valvuloplasty and annuloplasty can be performed
properly. Direct or patch closure of an ASD is feasible and a large myxoma can be removed.
Delicate sequential anastomoses of the LIMA to diagonal branches and LAD is feasible through
a small intercostal port. A proximal anastomosis can be made on the ascending aorta.
The Olympus Port-Access visualization system provides proper colour, contrast, resolution
and geometry, field of view and depth of field to fulfil these surgical acts properly. There is
no need for a wider access thanks to Heartport endoCPB and endoarterial clamp system
that are introduced in the femoral artery and vein.
Fluroscopy is mandatory to ensure safe positioning of the endoartic clamp in the ascending aorta.