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Valves: Lydia Richardson, Michael Richardson, and Steven Hunter Is a port-access mitral valve repair superior to the sternotomy approach in accelerating postoperative recovery? Interactive CardioVascular and Thoracic Surgery published on Apr 11, 2008 as doi:10.1510/icvts.2008.180182 [Abstract] [Journal Format PDF]

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

Roberto Gaeta, Fabrizio Tancredi, Franceso Monaco, Salvatore Lentini   (12 May 2008)

eComment. Port-access mitral valve repair in re-do surgery 12 May 2008
Roberto Gaeta Cardiac Surgery Unit, Policlinic Hospital, University of Messina, 98100 Messina, Italy, Fabrizio Tancredi, Franceso Monaco, Salvatore Lentini salvolentini{at}alice.it Roberto Gaeta, et al.	Interactive CardioVascular and Thoracic Surgery 2008, doi:10.1510/icvts.2008.180182A © 2008 European Association of Cardio-Thoracic Surgery We read with interest this collective review of Lydia Richardson and co-workers [1]. The authors focused on whether port-access mitral valve repair reduces the recovery period of patients compared to the conventional sternotomy approach. The 13 papers representing the best evidence on the subject, 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. This in spite of the longer reported operative time and increase in bypass time being around 30 min. The surgical experience of our group is of a total of 1734 minimally invasive cardiac surgical operations done either via a ministernotomy (921 pts) or a port access technique (813 pts) starting March 1997 to June 2007. We believe that a stronger evidence of advantages in terms of blood losses, complications and eventually hospital stay may be seen in re-do cases. In this group of patients, minimally invasive surgery (via either ministernotomy or port access technique) has reduced operative times. Re-do operation through a median sternotomy, with dissection of the adhesions is time-consuming. Reducing the width of the operative field, as in minimally invasive surgery, the total time of the operation is decreased and may be less than surgery performed by conventional sternotomy [2-4]. References [1] Richardson L, Richardson M, Hunter S. Is a port-access mitral valve repair superior to the sternotomy approach in accelerating postoperative recovery? Interact CardioVasc Thorac Surg doi:10.1510/icvts.2008.180182. [2] Byrne JG, Karavas AN, Adams DH, Aklog L, Aranki SF, Couper GS, Rizzo RJ, Cohn LH. Partial upper re-sternotomy for aortic valve replacement or re-replacement after previous cardiac surgery. Eur J Cardiothorac Surg 2000;18:282-6. [3] Svensson LG, Nadolny EM, Kimmel WA. Minimal access aortic surgery including re-operations. Eur J Cardiothorac Surg 2001;19:30-3. [4] Glower DD, Siegel LC, Frischmeyer KJ, Galloway AC, Ribakove GH,Grossi EA, Robinson NB, Ryan WH, Colvin SB. Predictors of outcome in a multicenter port-access valve registry. Ann Thorac Surg 2000;70:1054–1059.