Port-Access Aortic Valve Surgery: A Technique in Evolution

Authors

  • Grayson H. Wheatley, III
  • Syma L. Prince
  • Morley A. Herbert
  • William H. Ryan

DOI:

https://doi.org/10.1532/HSF98.20041104

Abstract

Background: Innovative minimally invasive surgical techniques have been developed for treating many cardiac diseases. We reviewed our experience with port-access aortic valve replacement (PAVR) surgery.

Methods: We retrospectively reviewed the charts of patients with aortic valve disease who underwent surgical correction using the Heartport System and minithoracotomy (PAVR) from January 1998 to December 2002 (n = 58) and matched them 1:1 with a cohort of patients who underwent AVR with conventional sternotomy.

Results: No preoperative statistical differences existed between the groups, including age, sex, New York Heart Association class, and ejection fraction. Perioperatively, there was a statistically significant difference between the AVR and PAVR groups with regard to aortic cross-clamp time (74.0 ± 22.9 minutes versus 92.7 ± 20.4 minutes, P < .01). Average operative times improved in the PAVR group by almost 83 minutes from the first 10 patients to patients 21 to 31 (P = .05). PAVR patients also averaged shorter stays in the intensive care unit (ICU) (1.5 days less) and hospital (1.8 days less) and were extubated sooner (4.9 hours). Mortality (1/58, 1.7%) and morbidity (reoperation for bleeding, infection, and stroke) were similar for both groups.

Conclusions: This minimally invasive approach to aortic valve surgery allows patients to be extubated earlier and promotes shorter stays in the ICU and hospital. These data suggest that the PA approach is an attractive alternative for patients requiring aortic valve surgery. There also appears to be a rapid surgeon learning curve.

References

Christiansen S, Stypmann J, Tjan TDT, et al. 1999. Minimally-invasive versus conventional aortic valve replacement--perioperative course and mid-term results. European J Cardiothorac Surg 16:647-52.nCohn LH. 2001. Minimally invasive valve surgery. J Card Surg 16:260-5.nReichenspurner H, Weltz A, Gulielmos V, Boehm DH, Reichart B. 1999. Port-access cardiac surgery using endovascular cardiopulmonary bypass: theory, practice, and results. J Card Surg 14:275-80.nRibakove GH, Miller JS, Anderson RV, et al. 1998. Minimally invasive port-access coronary artery bypass grafting with early angiographic follow-up: initial clinical experience. J Thorac Cardiovasc Surg 115:1101-10.nSchwartz DS, Ribakove GH, Grossi EA, et al. 1997. Minimally invasive mitral valve replacement: port-access technique, feasibility, and myocardial functional preservation. J Thorac Cardiovasc Surg 113:1022-31.nCohn LH, Adams DH, Couper GS, Bichell DP. 1997. Minimally invasive aortic valve replacement. Semin Thorac Cardiovasc Surg 9:331-6.nGalloway AC, Shemin RJ, Glower DD, et al. 1999. First report of the Port Access International Registry. Ann Thorac Surg 67:51-8.nGlower DD, Siegel LC, Frischmeyer KJ, et al. 2000. Predictors of outcome in a multicenter port-access valve registry. Ann Thorac Surg 70:1054-9.nGrossi EA, Galloway AC, Ribakove GH, et al. 2001. Impact of minimally invasive valvular heart surgery: a case-control study. Ann Thorac Surg 71:807-10.nKaur S, Balaguer J, Vander Salm TJ. 1998. Improved myocardial protection in minimally invasive aortic valve surgery with the assistance of port-access technology. J Thorac Cardiovasc Surg 116:874-5.nKort S, Applebaum RM, Grossi EA, et al. 2001. Minimally invasive aortic valve replacement: echocardiographic and clinical results. Am Heart J 142:476-81.nMohr FW, Falk V, Diegeler A, et al. 1998. Minimally invasive port-access mitral valve surgery. J Thorac Cardiovasc Surg 115:567-74.n

Published

2005-01-13

How to Cite

Wheatley, III, G. H., Prince, S. L., Herbert, M. A., & Ryan, W. H. (2005). Port-Access Aortic Valve Surgery: A Technique in Evolution. The Heart Surgery Forum, 7(6), E628-E631. https://doi.org/10.1532/HSF98.20041104

Issue

Section

Articles

Most read articles by the same author(s)