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Minimally Invasive Video-Assisted Mitral Valve Repair:
Short and Mid-Term Results Port-Accessª video-assisted surgery for mitral valve repair is an alternative for mid-sternotomy, but mid-term results are not yet available. Between February 1997 and December 1999, 121 patients underwent mitral valve surgery through a 4- to 5-cm right anterolateral thoracotomy using the Heartport® endovascular cardiopulmonary bypass; among these patients, 77 (57 males, 20 females; mean age 59 years; range 31-84 years) underwent mitral valve repair. Severe (4+) mitral regurgitation (MR) was seen in 63 patients (82%). Mean NYHA class was 2.5 ± 0.4. Standard Carpentier procedures were used in all patients; 11 had PTFE chordae for anterior leaflet prolapse. 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 patients (2.6%) had conversion to sternotomy for aortic dissection caused by the Endo-Aortic Clampª. Nine patients (11%) underwent revision for bleeding. Mean cross-clamp and perfusion times were 103 min and 140 min, respectively. Mean hospital stay was eight days. During follow up (mean 31 months) all patients improved their NYHA class; eight (11%) remained in class II. Left ventricular (LV) end-diastolic and LV end-systolic diameters decreased from 61 ± 7.3 mm to 53 ± 6.9 mm (p <0.01) and from 37 ± 6.8 mm to 34 ± 6.9 mm (p <0.05), respectively. Sixty-two patients (88%) had no or trivial MR, and nine (12%) had moderate MR (2+). There were two late valve replacements for endocarditis, and no late deaths. Port-Accessª mitral valve repair offers a valid alternative to the standard procedure, with good mid-term results, and is appears both safe and reproducible. |
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