Left Sided Heartport Approach for Combined Mitral Valve and Coronary Bypass Surgery

Abstract

Background: To explore the possibility of achieving adequate exposure of the mitral valve (MV) and the entire coronary anatomy using a limited (Port-Access) left lateral thoracotomy incision.

Methods: Using this incision, four patients underwent a single bypass to the left anterior descending, combined with MV repair (1), MV replacement (2), and left atrial (LA) myxoma excision (1). This approach required single lung ventilation, femoral venous cannulation, and cannulation of the femoral artery or thoracic aorta. Exposure of the MV was achieved through a LA incision parallel to the atrioventricular groove, extending into the pulmonary vein or behind the pulmonary artery as necessary.

Results: Excellent exposure of the MV and coronary anatomy was achieved in all patients. There were no surgical complications and all were discharged home within one week.

Conclusion: Left-sided Port-Access is a valid technique particularly suitable for combined primary MV and coronary bypass surgery. It does not allow exposure of the tricuspid or aortic valve, however, and is not recommended in repeat MV surgery due to the fragility of the LA appendage in such cases.