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Selami Dogan
Tayfun Aybek
Petar S. Risteski
Gerhard Wimmer-Greinecker
Anton Moritz
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Ann Thorac Surg 2005;79:492-498
© 2005 The Society of Thoracic Surgeons

Original article: Cardiovascular

Minimally Invasive Port Access Versus Conventional Mitral Valve Surgery: Prospective Randomized Study

Selami Dogan, MD*, Tayfun Aybek, MD, Petar S. Risteski, MD, Farooq Detho, Andrea Rapp, MD, Gerhard Wimmer-Greinecker, MD, PhD, Anton Moritz, MD, PhD

Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt am Main, Germany

Accepted for publication August 5, 2004.

* Address reprint requests to Dr Dogan, Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Theodor Stern Kai 7, 60590 Frankfurt am Main, Germany (E-mail: s.dogan{at}em.uni-frankfurt.de).

BACKGROUND: We compared the port access mitral valve surgery with the conventional procedure through median sternotomy in a prospective randomized study.

METHODS: Forty elective patients with mitral valve disease were prospectively randomized to undergo minimally invasive (group I) or conventional (group II) mitral valve operation. The patients of group I had limited access through right small anterior thoracotomy and a femorofemoral cardiopulmonary bypass system using the endoclamp technique. To assess the efficiency and safety of the procedure, intraoperative and postoperative clinical data and markers of myocardial, cerebral, and lower limb ischemia were collected. Pulmonary function tests were performed to compare the preservation of pulmonary function. Neuropsychological tests were conducted for quantification of neurological and cognitive disorders.

RESULTS: Mitral valve reconstructions were performed in 28 patients (70%) in both groups. Intraoperative procedure-associated problems were experienced in 9 patients (45%) in group I, and 6 of them (30%) had to be converted to direct transthoracic aortic clamping. Markers of myocardial and cerebral damage as well as pulmonary and neuropsychological tests did not show statistically significant difference between groups.

CONCLUSIONS: The minimally invasive port access technique for mitral valve surgery can be done with similar clinical safety as procedures through median sternotomy. The problems with endoclamping have forced us to change our practice to the more simple and economic transthoracic aortic clamping technique.




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