Video and Robotic-Assisted Minimally Invasive Mitral Valve Surgery: A Comparison of the Port-access and Transthoracic Clamp Techniques

Background In order to assess different surgical techniques for video-assisted minimally invasive mitral valve surgery, a retrospective study was undertaken comparing the Port-Access system (Cardiovations, Ethicon Inc, Somerville, NJ) and the transthoracic clamp technique. Methods In 120 patients mitral valve surgery was performed through a small right minithoracotomy using either the Port-Access endovascular cardiopulmonary bypass system (Port-Access, n = 60) or the transthoracic clamp technique (MICRO, n = 60). Mean patient age was 61.5 ± 10.5 years (81 patients with isolated mitral valve insufficiency, 39 patients with combined mitral valve disease). Results Eighty-one (67.5%) patients underwent mitral valve repair and 39 (32.5%) patients had valve replacement. Mean time of surgery was 4.5 ± 3.5 and 4.1 ± 3.2 hours (p = 0.07), aortic cross-clamp time 89 ± 69 and 78 ± 65 minutes (p = 0.08), mean intensive care unit stay 1.5 ± 2.1 and 1.6 ± 2.5 days (p = ns), and hospital stay 9.0 ± 10.5 and 9.2 ± 9.7 days (p = ns) in the Port-Access and MICRO groups, respectively. In the Port-Access group, there were 6 reexplorations for bleeding, one perforation of the right ventricle with the endopulmonary vent, and 2 reconstructions of the femoral artery necessary after femoral cannulation, compared to one reexploration for bleeding in the MICRO group. There was only one minor paravalvular leak after replacement and 2 cases of residual greater than or equal to grade II mitral valve regurgitation after mitral valve repair in the Port-Access group, necessitating reoperation. In both groups, there was no mortality, no cerebrovascular accident, no aortic dissection, and no conversion to sternotomy. Conclusions Minimally invasive mitral valve surgery has become a standard approach for isolated mitral valve operations at our institution. The MICRO technique tends to shorten the time of surgery and aortic cross-clamping and reduces perioperative costs by simplifying the operative procedure.