Introduction : Port-Access™ video-assisted surgery for Mitral Valve Repair (MVR) as an alternative for mid-sternotomy is feasable. Mid-term results are not known yet.
Patients and methods : Between February 1997 and December 1999, 121 consecutive patients (pts) underwent mitral valve surgery through a small right antero-lateral thoracotomy using the Heartport® endo-CPB, 77 pts (57 male) of whom underwent MVR. Mean age was 59 years (31-84). Severe (4+) mitral regurgitation (MR) was seen in 63 pts (82%). Mean NYHA Class was 2,5 ±0,4. Standard Carpentier MVR procedures were used in all pts; 11 had PTFE chordae for anterior leaflet prolaps.
Results : Pathologies were degenerative (n=69), chronic endocarditis (n=4), annular dilatation (n=3) and rheumatic (n=1). Hospital mortality was 1,3% (n=1). Two pts (2,6%) had conversion to sternotomy for aortic dissection with the Endo-Aortic Clamp™. Nine pts (11%) underwent revision for bleeding. Mean cross clamp and mean perfusion time was 103 min. (24-160) and 140 min. (75-215) respectively. Mean hospital stay was 8 days (4-36).
At clinical follow-up (19,6 months, range 5-41) all patients improved their NYHA class; 8 pts (11%) remains in Class II. At echocardiography, LV end-diastolic and LV end-systolic diameters decreased from 61 ±7,3 to 53± 6,9 (t=7,52 - p<0,01) and 37±6,8 to 34±6,9 (t=2,43 p<0,05) respectively. Sixty two pts (88%) had no or trivial MR and 9 pts (12%) had moderate MR (2+).
There were two late valve replacements for endocarditis and no late deaths.
Conclusion : Port-Access™ MVP constitutes a valid alternative to standard procedure with good mid-term results.