Minimally invasive mitral valve surgery via minithoracotomy and direct cannulation

BACKGROUND: To reduce the morbidity of mitral valve operations, a right anterolateral minithoracotomy under direct vision was introduced. We report our experience with this procedure. METHODS: From July 2001 to December 2013, 320 consecutive patients underwent direct minimally invasive mitral valve surgery through a right anterolateral minithoracotomy at our institution. Evidence of rheumatic disease was observed in 231 (72%) patients, and 89 (28%) repaired valves had myxomatous changes. Tricuspid valve repair was performed in 80 (25%) patients and radiofrequency ablation in 80 (25%) with chronic atrial fibrillation. All cannulas were introduced through the thoracotomy incision, eliminating femoral cannulation. No new instruments, retractors, or ports were used. Pleural and pericardial drainage was accomplished through a single drain. RESULTS: There was no hospital death. Conversion to sternotomy was needed in 3 patients because we were unable to obtain satisfactory arterial cannulation. Eight patients required reoperation: 7 for mitral insufficiency and one for postoperative bleeding. Mean cardiopulmonary bypass and crossclamp times were 55.3 ± 17.0 and 43.0 ± 13.4 min, respectively. Mean intensive care unit stay was 29 h, and hospital stay was 4.3 days. CONCLUSIONS: Based on our experience, this minimally invasive approach is safe, rapid, cost-effective, and more comfortable for the patients, in addition to its cosmetic benefits. It may be the preferred approach in young females.