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First report of the Port Access International Registry
A C Galloway1, R J Shemin, D D Glower
1New York University Medical Center, New York 10016, USA.
Insights
Minimally invasive cardiac surgery using the Port Access (PA) method, including coronary artery bypass grafting (CABG) and mitral valve procedures, demonstrates comparable safety and low mortality rates to traditional open-chest operations.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Procedures
- Surgical Outcomes
Background:
- Minimally invasive cardiac surgery requires risk profiles comparable to open-chest procedures for widespread adoption.
- The Port Access (PA) International Registry was utilized to assess the safety and efficacy of minimally invasive cardiac operations.
Purpose of the Study:
- To evaluate the operative risks and outcomes of minimally invasive cardiac surgery using the Port Access (PA) technique.
- To compare the safety of PA coronary artery bypass grafting (CABG) and mitral valve operations against established benchmarks.
Main Methods:
- Analysis of data from the multicenter Port Access (PA) International Registry.
- Inclusion of 1,004 patients who completed PA procedures (583 CABG, 184 mitral valve replacement, 137 mitral valve repair) across 121 centers.
Main Results:
- Port Access procedures were successfully completed in 94% of attempted cases (1,004/1,063).
- Low operative mortality rates were observed: 1% for PA CABG, 3.3% for PA mitral valve replacement, and 1.5% for PA mitral valve repair.
- Perioperative morbidity was minimal, with low incidences of stroke, myocardial infarction, reoperation, renal failure, and multiorgan failure.
Conclusions:
- Port Access (PA) coronary artery bypass grafting (CABG) and mitral valve operations are safe procedures.
- Morbidity and mortality rates for PA cardiac operations are similar to those of conventional open-chest surgery.
- Further research is needed to ascertain the long-term efficacy and recovery benefits of the Port Access method.
Background:
For minimally invasive cardiac operations to be widely applicable, the risks must be equivalent to those of standard open-chest operations. This study analyzed the outcomes of patients recorded in the multicenter Port Access (PA) International Registry to establish operative risks.
Methods:
Data were analyzed for intent to treat in 583 patients who underwent PA coronary artery bypass grafting (CABG), 184 who underwent PA mitral valve replacement, and 137 who underwent PA mitral valve repair at 121 centers.
Results:
Port Access was attempted in 1,063 patients and completed in 1,004 (94%). The operative mortality rate was 1% for PA CABG, 3.3% for PA mitral valve replacement, and 1.5% for PA mitral valve repair. Perioperative morbidity was low in all categories: stroke = 1.1% to 3.6%, myocardial infarction = 0 to 1%, primary procedure reoperation = 0 to 0.7%, renal failure = 0.2% to 0.7%, multiorgan failure = 0 to 0.5%, and atrial fibrillation = 5% to 7.3%.
Conclusions:
Data on 1,063 patients from 121 centers demonstrate that PA CABG and PA mitral valve operations can be performed safely, with morbidity and mortality rates similar to those associated with open-chest operations. Further studies are indicated to establish the long-term efficacy of this method and to analyze its effect on recovery time.