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J Thorac Cardiovasc Surg. 2010 Jul;140(1):86-90. doi: 10.1016/j.jtcvs.2009.09.035. Epub 2009 Dec 6.

Quality of mitral valve repair: median sternotomy versus port-access approach.

Author information

1
Department of Cardiac Surgery, Chaim Sheba Medical Center, Tel Hashomer, Israel. ehud.raanani@sheba.health.gov.il

Abstract

OBJECTIVES:

We sought to compare early and late clinical and echocardiographic outcomes of patients undergoing minimally invasive mitral valve repair by means of the port-access and median sternotomy approaches.

METHODS:

Between 2000 and 2009, 503 patients had mitral valve repair, of whom 143 underwent surgical intervention for isolated posterior leaflet pathology: 61 through port access and 82 through median sternotomy. The port-access group had better preoperative New York Heart Association functional class (P = .007) and a higher rate of elective cases (97% vs 87%, P = .037). Other preoperative characteristics were similar between the groups, including mitral valve pathology and repair techniques.

RESULTS:

Operative, bypass, and clamp times were significantly longer in the port-access group. Mean hospital stay was 5.3 +/- 2.5 days in the port-access group versus 5.7 +/- 2.5 days in the median sternotomy group (P = .4). Early postoperative echocardiographic analysis showed that most patients in both groups had none or trivial mitral regurgitation and none of the patients had greater than grade 2 mitral regurgitation. Follow-up extended for up to 100 months (mean, 34 +/- 24 months). New York Heart Association class improved in both groups (P = .394). Freedom from reoperation was 97% and 95% in the port-access and median sternotomy groups, respectively. Late echocardiographic analysis revealed that 82% (49/60) in the port-access group and 91% (73/80) in the median sternotomy group were free from moderate or severe mitral regurgitation (P = .11).

CONCLUSIONS:

In isolated posterior mitral valve pathology, quality of mitral valve repair with the port-access approach can compare with that with the conventional median sternotomy approach.

PMID:
19969315
DOI:
10.1016/j.jtcvs.2009.09.035
[Indexed for MEDLINE]
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