Original Articles
Minimally Invasive Valve Operations

Presented at the Thirty-third Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Feb 3–5, 1997.
https://doi.org/10.1016/S0003-4975(98)00300-2Get rights and content

Abstract

Background. To reduce the morbidity from valvular heart operations, a right parasternal approach was introduced. We report our initial experience with the procedure.

Methods. From January 1996 through July 1996, 115 patients underwent primary isolated valve procedures. One hundred (85%) patients underwent the operation through a right parasternal incision.

Results. There was one hospital death secondary to a stroke on the fifth postoperative day. Three patients (two with aortic valve operations and one having a mitral valve procedure) required conversion to sternotomy. Mean aortic occlusion time was 71 minutes; mean cardiopulmonary bypass time was 93 minutes. Mean stay in the intensive care unit was 27 hours and mean hospital postoperative stay was 5.7 days. Seventy-seven percent of the patients did not receive blood transfusions. Comparison with median sternotomy demonstrated a reduction in both postoperative length of stay and direct hospital costs.

Conclusions. We conclude that this minimally invasive approach is safe for a variety of valve procedures and is effective in reducing surgical trauma and cost.

Section snippets

Material and methods

This surgical technique has been previously reported 1., 2.. From January 1996 through July 1996, 115 patients underwent primary isolated valve operations. One hundred (85%) patients underwent a minimally invasive procedure. Demographics for this group are shown in Table 1.

The surgical procedure for the aortic valve was replacement in 72% of patients. Repair was accomplished in 28% of the patients requiring aortic valve procedures. Mitral valve procedures comprised 98% repair and 2%

Results

There was one hospital death in a patient undergoing aortic valve replacement. This patient sustained a cerebrovascular accident unrelated to the procedure or incision on the fifth postoperative day. Complications are noted in Table 4.

Three patients required conversion to a median sternotomy; two had aortic valve procedures and one underwent a mitral valve procedure. Both aortic valve procedures required performance of unexpected coronary artery bypass grafts. The mitral valve procedure was

Comment

Evaluation of any new surgical approach requires a careful analysis of its real and potential advantages and disadvantages when compared with a standard procedure. Our initial experience with this approach suggests several definite advantages. The incision is cosmetically more acceptable than a median sternotomy. Pain was reduced although it differed in character. Pain is localized to the anterior chest wall and is well controlled with an intercostal block performed at the time of the

Addendum

Since this initial experience of 100 operations performed through a parasternal incision, we have had an opportunity to expand our experience further. With additional experience we found that occasionally the approach to the aortic valve gave less than optimal exposure. Further, resection of the third and fourth costal cartilages occasionally resulted in instability to the small portion of the anterior chest wall, which proved to be aesthetically unattractive in some patients. Other

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