Is Port-Access Applicable To Complex Mitral Valve Repair?

Background: The suitability of the Port-Access approach to complex mitral valve repair remains controversial and has not been documented.Methods: Retrospective analysis was performed of 161 consecutive patients undergoing mitral repair for mitral regurgitation (MR) using Port-Access at a single institution from 1996-2001 using direct visualization of the mitral valve through a 6 cm right anterolateral thoracotomy. Repair was classed as annuloplasty alone (ANN, N=39), complex valvuloplasty (CX, N=25) requiring chordal repair of the anterior leaflet, or any other valvuloplasty (VAL, N=97).Results: CX patients were similar to VAL patients but differed from ANN patients in being more male (17/25(68%) vs 15/39(38%)), having less ischemic disease (1/25(4%) vs 9/39(23%)), less prior procedures (1/25(4%) vs 8/39(21%)), and higher ejection fraction (50 + 7% vs 39 + 12%). CX patients had clamp times and pump times longer than ANN but not different from VAL. Mortality was 0/25(0%) for CX and 1/161 overall. Intraoperative echo showed no difference in grade of residual MR (p=0.6 CX vs ANN or VAL) (none > 1+). At a median follow-up of 12 months, CX patients did not differ from VAL or ANN in degree of late MR (p=0.7) or need for late mitral reoperation (p=0.14). Two CX patients were reoperated, 1 for endocarditis, 1 for recurrent mitral regurgitation.Conclusions: This single institution experience demonstrates that complex mitral repair using Port-Access can achieve excellent short term results comparable to those from less complex repairs. Although longer follow-up is needed, Port-Access or other limited access techniques need not be withheld from patients requiring complex repair once the surgical team becomes comfortable with limited access.