The Preferable Use of Port Access Surgical Technique for Right and Left Atrial Procedures
We analyzed the results of mitral valve operations, either alone or in any combination with the tricuspid valve surgeries in the period from January 2001 till June 2004. The period was divided into two parts, classical sternotomy part (C) (110 patients) and minimally invasive port access part (PA) (105 patients), later being used from December 2002 till now. Also, what we were interested in was the total hospital cost of both types of the procedures and if there are any advantages of port access over the classical sternotomy. The mean age was 61.2 10.2 and 60.3 12.4 (C versus PA) and mean additive Euroscore was 6.5 versus 4.8 (C versus PA). There were statistically significant differences (P < .0001) in cardiopulmonary bypass time (CPB) and aortic cross-clamp time (AXT) between both groups: CPB C versus PA: 98.3 33.5 minutes versus 149.2 44.2 minutes (mean sd), AXT C versus PA: 62.9 20.6 minutes versus 88.3 26.8 minutes (mean sd). There were no statistically significant differences in mortality and stroke for both the groups (mortality P = 1, stroke P = .53).
There were statistically significant differences in favor of the port access over the classical one for: intensive unit stay (P = .004), postoperative stay in days (P < .0001), blood transfusion (P < .0001), postoperative thoracic bleeding (P < .0001), and extubation time in hours (P < .0001). Furthermore, costs analyses showed that the average total patient cost was less for port access (P < .0005). The differences between endo and classical type suggested that the port access type of surgery is 20% cheaper than the classical one. We may conclude that port access surgery is an acceptable alternative to classical type of surgery, also in complex pathology of the mitral and tricuspid valve.
Greco E, Barriuso C, Castro MA, et al. 2002. Port-Access™ cardiac surgery: from a learning process to the standard. Heart Surg Forum 5(2):145-9.nHellgren L, Kvidal P, Stahle E. 2002. Improved early results after heart valve surgery over the last decade. Eur J Cardio-thorac Surg 22:904-11.nKypson AP, Glower DD. 2002. Minimally invasive tricuspid operation using port access. Ann Thorac Surg 74:43-5.nSchroeyers P, Wellens F, De Geest R, et al. 2001. Minimally invasive video-assisted mitral valve surgery: our lessons after a 4-year experience. Ann Thorac Surg 72:S1050-4.nDogan S, Aybek T, Risteski PS, et al. 2005. Minimally invasive port >access versus conventional mitral valve surgery: prospective randomized study. Ann Thorac Surg 79:492- 8.nGersak B, Trobec R, Krisch I, Psenicnik M. 1996. Loss of endothelium-mediated vascular relaxation as a response to various clamping pressures. Eur J Cardio-thorac Surg 10:684-9.nReichenspurner H, Detter C, Deuse T, et al. 2005. Video and robotic->assisted minimally invasive mitral valve surgery: a comparison of the port-access and transthoracic clamp techniques. Ann Thorac Surg 79:485-91.nTripp HF, Glower DD, Lowe JE, Wolfe WG. 2002. Comparison of port access to sternotomy in tricuspid or mitral/tricuspid operations. Heart Surg Forum 5(2):136-40.n
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