ABSTRACT 101

MINIMALLY INVASIVE MITRAL VALVE SURGERY THREE YEARS CLINICAL EXPERIENCE

Yugal  Mishra, Kirshna K Sharma, Yatin Mehta, Naresh Trehan
Escorts Heart Institute And Research Centre, New Delhi, India

Objective: In order to minimise surgical trauma video-assisted mitral valve surgery was performed employing either the port access technique or alternatively using transthoracic clamps.

Methods: From Oct.’97 to Sept. 2000, mitral valve surgery was performed in 221 patients through a small right minithoracotomy using either port access endovascular CPB system (n=38) or alternatively a thransthoracic clamp (n=183) instead of the endoaortic balloon catheter, allowing direct aortic cross clamping and application of cardioplegia. In 120 patients exposure of the mitral valve was facilitated with a endoscope attached to a voice controlled robotic arm (AESOP) allowing stabilization and voice activated camera positioning. Mitral valve repair was performed in 26 patients. In 195 patients the valve was replaced. Mitral valve surgery was primary cardiac procedure in 197 patients, but 24 were redocases.

Results: Median time of surgery for all patients was 3.5 h and aortic cross clamp time 54 min. Median ICU stay was 14 h and hospital stay 6 days. There was no perivalvular leak after mitral valve replacement and mitral valve regurgitation or stenosis after repair. There was no re-exploration for bleeding. Median post operative blood loss was 260 ml. There was one hospital mortality. On mean follow up period of 16.4±12.2 months there was no late death or re-operation. Patients had improvement in their function class from 2.6±0.5 preoepative level to 1.4±0.8 post operative level.

Conclusion: Using video and robotic assistance it was possible to minimise the length of incision but also allowing visualisation of the whole mitral valve apparatus. Employing the transthoracic clamp technique shortens the time of surgery, facilitates complete aortic cross clamping, application of cardioplegia and reduces costs.