Long term comparison of minimally invasive port access and conventional median sternotomy methods in isolated mitral valve replacement patients

ABSTRACTObjective: Mitral valve operations are the most proceded operations when all valve operations are considered. Mitral valve replacement is the most frequent procedure in this group of surgery. İn recent years, to the parallel of technological advancements toracoscopic and robotic surgery advanced as well. Once, for the mitral valve replacement median sternotomy technic was to be prefered generally, but in the recent years because of its comfort, good cosmetic results and high successfull result rates for the patients, minimally invazive port access technic became a good option for the process.Our study is designed to delineate differences in early and late term post operative outcomes from isolated mitral operation via port access versus sternotomy in comparable patients.Method: The patients were whom undergone isolated mitral valve replacement between 2002-2007, divided into two groups as minimally invasive port access(group 1, n=28) group and median sternotomy (group 2, n=29) group according to their operation process. The records of 57 consecutive patients that ages were between 25 and 75, average age in group 1 was 43,68+13,67, in group 2 was 49,90+ 12,78 retrospectively examined. Both groups were examined in the aspect of demographic datas(age, gender, body weight), morbidity factors(diabetes, chronic obstructive lung disease, cerebrovascular event), operational variables(KPB and AC time), peroperational bleeding, reoperation requirement, transfusions, inotropic administration, ritm irregularities, in İCU and hospital stay, post operative complications and mortalities.Results: Both groups were well matched for age, gender, mitral pathology, ejection fraction, comorbidity and post operative complications. Preoperative NYHA outcomes were higher for median sternotomy (group 2) patients than port Access (group 1) patients(p = 0,006 < 0,05). Cardiopulmonary bypass time was longer for port access patients (156,6±38,9) than median sternotomy patients (81,0±12,6), (p=0,000 < 0,05). Aortic clamp time was longer for port access patients (98,11±28,8) than median sternotomy patients (55,3±12,0). This was related with the relative difficulty of the minimally invazive method. İCU adrenalin administration ratio was higher for port access patients (% 82,1) than median sternotomy patients(%55,2), (p=0,029 < 0,05). No complications were found related femoral cannulation. İn each group one patient required reexploration because of bleeding. One patient developed endocarditis with minimally paravalvular leakage that medically cured. Two patients developed pannus formation in group 2. One patient required reoperation because of pannus formation, high valvular gradient and clinical complaints, one patient did recommended reoperation. İn each group two patients died. One from cardiac failure in group 1, other deaths were because of non cardiac reasons.Conclusions: Despite the long cardiopulmonary bypass and aortic clemp times early and late term morbidity and mortality rates and functional capacities of the patients were similar thus port access method was found safe and as effective as median sternotomy when compared. Port access method is a good option for both patients and surgeons in regard a better pain perception, faster mobilization, faster healing, better cosmetic and acceptible long term follow up results.