Port-Access-Assisted Aortic Valve Replacement: A Comparison of Minimally Invasive and Conventional Techniques


  • Bradley G. Leshnower
  • Candace S. Trace
  • Robert S. Boova




Background. A hybrid Port-Access (PA) approach to aortic valve surgery (MPAVR) was designed as a less invasive aortic valve operation. The approach combines components of Port-Access technology with conventional cardiac surgical techniques via a limited sternal incision. This technique is compared to conventional aortic vale replacement (CAVR) for safety and efficacy.

Methods. One hundred eighty patients had aortic valve surgery between January 1, 2000, and June 30, 2004. Fifty-eight patients (32%) had primary isolated aortic valve replacement, 22 of those 58 patients (38%) underwent MPAVR procedures consisting of a limited inverted-T sternotomy, direct aortic cannulation, a percutaneous PA endocoronary sinus cardioplegia catheter, an endovent pulmonary artery catheter, and a percutaneous femoral endovenous return catheter. Thirty-six patients (62%) had aortic valve replacement by sternotomy and standard cardiopulmonary bypass techniques. The MPAVR and CAVR groups were compared for demographics and intraoperative and postoperative outcomes.

Results. Age, obesity, diabetes, New York Heart Association classification, ejection fraction, and other patient characteristics were not significantly different between the groups. MPAVR patients had lower Society of Thoracic Surgery risk scores (3.1 versus 3.9; P = .277). MPAVR patients were more likely to receive a stentless valve (36% versus 11%; P = .042) and required longer operative times (237 min versus 189 min; P <.001). Postoperative complications were minimal and equivalent. A single mortality in the CAVR group resulted in an overall mortality of 1.7%.

Conclusion. This hybrid, less invasive PA-assisted approach to aortic valve surgery is safe and effective. A total sternotomy can be avoided in selected aortic valve patients. Results equivalent to CAVR can be expected with this minimal access operation.


Aris A. 1999. Reversed "C" ministernotomy for aortic valve replacement. Ann Thorac Surg 67:1806-7.nCohn LH, Adams DH, Couper GS, et al. 1997. Minimally invasive aortic valve replacement. Semin Thorac Cardiovasc Surg 9:331-6.nChitwood WR Jr. 2001. Minimally invasive aortic valve surgery: what is "port access"? Am Heart J 142:391-2.nCitterio E, Manasse E, Pilato E, et al. 2001. Port-access cardiac surgery: clinical experience with first 50 cases. Ital Heart J 2:904-9.nAkpinar B, Guden M, Sagbas E, et al. 2003. Combined radiofrequency modified maze and mitral valve procedure through a port access approach: early and mid-term results. Eur J Cardiothorac Surg 24: 223-30.nCarpentier A, Loulmet D, Le Bret E, et al. 1996. Open heart operation under videosurgery and minithoracotomy. First case (mitral valvulo-plasty) operated with success [in French]. C R Acad Sci III 319:219-23.nChristiansen S, Stypmann J, Tjan TD, et al. 1999. Minimally-invasive versus conventional aortic valve replacement--perioperative course and mid-term results. Eur J Cardiothorac Surg 16:647-52.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.nMachler HE, Bergmann P, Anelli-Monti M, et al. 1999. Minimally invasive versus conventional aortic valve operations: a prospective study in 120 patients. Ann Thorac Surg 67:1001-5.nCosgrove DM, Sabik JF. 1996. Minimally invasive approach for aortic valve operations. Ann Thorac Surg 62:596-7.nOnnasch JF, Schneider F, Falk V, et al. 2002. Minimally invasive approach for redo mitral valve surgery: a true benefit for the patient. J Card Surg 17:14-9.nPompili MF, Stevens JH, Burdon TA, et al. 1996. Port-access mitral valve replacement in dogs. J Thorac Cardiovasc Surg 112:1268-74.nSchroeyers P, Farhat F, Van Praet F, et al. 2000. Video-assisted port-access combined mitral valve and CABG surgery. J Heart Valve Dis 9:783-5.nStevens JH, Burdon TA, Peters WS, et al. 1996. Port-access coronary artery bypass grafting: a proposed surgical method. J Thorac Cardiovasc Surg 111:567-73.nSvensson LG. 1997. Minimal-access "J" or "j" sternotomy for valvular, aortic, and coronary operations or reoperations. Ann Thorac Surg 64:1501-3.nFann JI, Pompili MF, Stevens JH, et al. 1997. Port-access cardiac operations with cardioplegic arrest. Ann Thorac Surg 63:S35-9.nGalloway AC, Shemin RJ, Glower DD, et al. 1999. First report of the Port Access International Registry. Ann Thorac Surg 67:51-6; discussion 57-8.nGillinov AM, Banbury MK, Cosgrove DM. 2000. Hemisternotomy approach for aortic and mitral valve surgery. J Card Surg 15:15-20.nGlower DD, Landolfo KP, Clements F, et al. 1998. Mitral valve operation via port access versus median sternotomy. Eur J Cardiothorac Surg 14(Suppl 1):S143-7.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.nKort S, Applebaum RM, Grossi EA, et al. 2001. Minimally invasive aortic valve replacement: echocardiographic and clinical results. Am Heart J 142:476-81.nMcCreath BJ, Swaminathan M, Booth JV, et al. 2003. Mitral valve surgery and acute renal injury: port access versus median sternotomy. Ann Thorac Surg 75:812-9.nTripp HF, Glower DD, Lowe JE, et al. 2002. Comparison of port access to sternotomy in tricuspid or mitral/tricuspid operations. Heart Surg Forum 5:136-40.nWheatley GH, Prince SL, Herbert MA, et al. 2004. Port-access aortic valve surgery: a technique in evolution. Heart Surg Forum 7:E628-31.n



How to Cite

Leshnower, B. G., Trace, C. S., & Boova, R. S. (2006). Port-Access-Assisted Aortic Valve Replacement: A Comparison of Minimally Invasive and Conventional Techniques. The Heart Surgery Forum, 9(2), E560-E564. https://doi.org/10.1532/HSF98.20051111