Minimally Invasive Valvular Surgery
transfusions and the mean hospital stay was only five days. The authors observed that post-operative pain and return to "normality" were improved compared to sternotomy patients.
Cosgrove reported results in 115 patients undergoing isolated mitral or aortic valve surgery using a parasternal incision.(8) The operative risk in this series was 1%. Seventy-seven percent of the patients did not receive blood and the mean hospital stay was five days. The authors concluded that the less invasive approach reduced surgical trauma, blood utilization and length of hospital stay.
At the 1997 American Heart Association Scientific Sessions we reported the initial NYU results with Port-Access minimally invasive valvular surgery.(22) The operative risk was 1.1% for isolated mitral valve surgery. The overall echocardiographic and clinical effectiveness of the valve operation was equivalent to that achieved with open-chest surgery, but with less post-operative pain, fewer overall complications and a shorter recovery time. A case-matched analysis of all patients undergoing valvular heart surgery at NYU over three years demonstrated that patients having the Port-Access minimally invasive approach had significantly shorter hospital stays and required less blood transfusion than did sternotomy patients. Similarly, a multi-center report from 121 centers in the Port-Access International Registry by Galloway et al, demonstrated an extremely low overall morbidity for patients having Port-Access mitral valve surgery, and more widespread use of the technique was recommended.(9)
In keeping with the above-noted trends toward more natural approaches to valvular surgery is the substantial impact that minimally invasive techniques are having on patient recovery and quality of life. Glower from Duke University reported that early postoperative recovery and quality of life were better after Port-Access mitral valve surgery than after sternotomy.(23) Similarly, a recently completed prospective trial from NYU, which compared Port-Access minimally invasive with conventional sternotomy approaches for coronary artery bypass, demonstrated lower pain scores, less catecholamine stress response, better early recovery of pulmonary function and a better Duke Activity quality of life score over the first month post-operatively in the minimally invasively treated group .
Thus, a growing body of data indicates that minimally invasive techniques may soon become a new standard for patients requiring valvular heart surgery. This is certainly the case at our institution, where the vast majority of patients requiring valve repair or replacement surgery now have a minimally invasive procedure.
| Over the past three to four years "minimally invasive" cardiac surgery has been introduced for the surgical treatment of valvular heart disease. The basic premise is that by minimizing the operative incision and the amount of trauma and pain, recovery time will be shortened. Several new techniques have been proposed for this need. Intermediate, but less invasive,approaches included parasternal and mini-sternotomy incisions using conventional cardiopulmonary bypass technology. (8,13,14,15) More technologically advanced approaches include video-assisted surgery through a small thoracotomy, and the Port-Access approach. (6,17,18,19,20,21,22,23) The mini-sternotomy and parasternal approaches involve central cannulation and direct aortic crossclamping. The Port-Access technique employs a small mini-thoracotomy, using a specially designed catheter system for balloon aortic occlusion and cardioplegia delivery (Port-Access, Heartport, Inc.). (18,19,20,21,22) In all cases, emerging data suggest that there are measurable clinical and physiologic benefits with these less invasive operative techniques. Cohn recently reported results with 100 patients undergoing minimally invasive mitral valve repair or replacement, using a right parasternal incision.(14) Operation was successfully completed in all patients. Sixty percent of the patients required no blood |
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Cosgrove reported results in 115 patients undergoing isolated mitral or aortic valve surgery using a parasternal incision.(8) The operative risk in this series was 1%. Seventy-seven percent of the patients did not receive blood and the mean hospital stay was five days. The authors concluded that the less invasive approach reduced surgical trauma, blood utilization and length of hospital stay.
At the 1997 American Heart Association Scientific Sessions we reported the initial NYU results with Port-Access minimally invasive valvular surgery.(22) The operative risk was 1.1% for isolated mitral valve surgery. The overall echocardiographic and clinical effectiveness of the valve operation was equivalent to that achieved with open-chest surgery, but with less post-operative pain, fewer overall complications and a shorter recovery time. A case-matched analysis of all patients undergoing valvular heart surgery at NYU over three years demonstrated that patients having the Port-Access minimally invasive approach had significantly shorter hospital stays and required less blood transfusion than did sternotomy patients. Similarly, a multi-center report from 121 centers in the Port-Access International Registry by Galloway et al, demonstrated an extremely low overall morbidity for patients having Port-Access mitral valve surgery, and more widespread use of the technique was recommended.(9)
In keeping with the above-noted trends toward more natural approaches to valvular surgery is the substantial impact that minimally invasive techniques are having on patient recovery and quality of life. Glower from Duke University reported that early postoperative recovery and quality of life were better after Port-Access mitral valve surgery than after sternotomy.(23) Similarly, a recently completed prospective trial from NYU, which compared Port-Access minimally invasive with conventional sternotomy approaches for coronary artery bypass, demonstrated lower pain scores, less catecholamine stress response, better early recovery of pulmonary function and a better Duke Activity quality of life score over the first month post-operatively in the minimally invasively treated group .
Thus, a growing body of data indicates that minimally invasive techniques may soon become a new standard for patients requiring valvular heart surgery. This is certainly the case at our institution, where the vast majority of patients requiring valve repair or replacement surgery now have a minimally invasive procedure.