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Is a port-access mitral valve repair superior to the sternotomy approach in accelerating postoperative recovery?

^a Medical Student, Brighton and Sussex Medical School, Brighton, East Sussex, UK
^b General Practitioner, Hadleigh House Surgery, The Kirkway, Broadstone, Dorset, UK
^c Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK

*Corresponding author. Tel./fax: +44 7894 559594.

E-mail address: l.e.richardson{at}bsms.ac.uk (L. Richardson).

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether port-access mitral valve repair reduces the recovery period of patients compared to the conventional sternotomy approach. Using the reported search, 778 papers were identified. Thirteen papers represented the best evidence on the subject and the author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study comments and weaknesses were tabulated. The 13 papers demonstrated that patients who undergo minimally invasive mitral valve repair have a shorter ICU and total hospital stay than those who undergo the sternotomy approach. Results vary but mean hospital stays range from 5.6 to 13 days in port-access groups compared to 6.25–15 days in sternotomy groups. Other advantages over the sternotomy approach were reduced postoperative bleeding and pain, shorter time to extubation and a quicker return to daily activities. However, it is consistently reported that operative time is longer, with the increase in bypass time being around 30 min. We conclude that in several cohort studies minimally invasive mitral valve repair is reported to result in a shorter ICU and hospital stay, reduced postoperative bleeding and pain and a shorter time to resuming normal activities. This is at the expense of longer bypass and operative times.

Key Words: Minimally invasive mitral valve repair; Sternotomy; Hospital/ICU stay

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eComment: Port-access mitral valve repair in re-do surgery

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				R. Gaeta, F. Tancredi, F. Monaco, and S. Lentini eComment: Port-access mitral valve repair in re-do surgery Interactive CardioVascular and Thoracic Surgery, August 1, 2008; 7(4): 683 - 683. [Full Text] [PDF]