Video-assisted minimally invasive (port access) cardiac surgery: Early results

Abstract

Objective: This study was conducted to evaluate early results of video-assisted minimally invasive atrial septal defect closure and mitral valve surgery operations. Material and Methods: Between January and December 2002, 8 atrial septal defect (ASD) closure, 38 mitral valve replacement and 16 mitral valve repair operations were performed (n=62). The concomitant procedures were radiofrequency ablation procedure for the treatment of atrial fibrillation (n=31) and tricuspid valve repair (n=7). The mean age of the patients was 27±10.1 years in ASD group, 51.8±11 years in mitral valve replacement group, 48.2±12.5 years in mitral valve repair group. The female/male ratio was 6/2 in ASD group, 28/10 in mitral valve replacement group and 10/6 in mitral valve repair group. Mean ejection fraction was 45±7%. Cardiopulmonary bypass was initiated via femoral artery, femoral vein, percutaneous juguler vein cannulation. Procedures were performed through a 4-6 cm. anterolateral right mini thoracotomy incision with the assistance of 5 mm. endoscope. Aorta was cross-clamped using a transthoracic clamp (Chitwood), and cardioplegic arrest was achieved via antegrade blood cardioplegia. Results: Ischemic time was 39.1±14.2 minutes in ASD group. 102.2±29.4 minutes in mitral valve replacement group, and 111.1±23.3 minutes in mitral valve repair group. Total CPB time was 93.3±24.1 minutes in ASD group, whereas 158±30.8 minutes in mitral valve replacement group and 166.6±24.1 minutes in mitral valve repair group. Intensive care unit and hospital stay were 1 and 5±0.9 days for ASD group, respectively, 1.7±1.2 and 7.1±1.2 days in mitral valve replacement group and 1.8±1.3 and 8±1.7 days in mitral valve repair group. There was only one mortality due to pulmonary infection (1.6%). Myocardial infarction, neurological event or complication due to cannulation were not observed. There were 2 reoperations due to bleeding (3.2%). There were no procedure related complications. Transesophageal echocardiography at the end of the operation revealed competent mitral valves with no insufficiency in 14 patients and minimal regurgitation in two patients in the repair group and no leakage in ASD closure and mitral valve replacement group. Conclusion: Video assisted minimally invasive valve and ASD closure operations could be performed safely and efficiently. This technique provides better cosmetic and reliable surgical results with superior patient satisfaction. We can recommend this technique in selected group of patients.