Minimally invasive mitral valve surgery: mini-sternotomy with extended transseptal approach

A partial upper sternotomy and an extended transseptal incision provide excellent exposure for mitral valve surgery. From March 1997 to December 1998, 462 patients had mitral valve surgeries using this minimally invasive approach. Eighty-seven percent had mitral valve repair, and 13% had mitral valve replacement. Thirteen patients (3%) required conversion to full sternotomy, and all other patients had the procedure completed using the initial approach. Forty-eight percent of patients were extubated within 6 hours of surgery, and 47% of patients spent less than 24 hours in the intensive care unit (ICU). Mean hospital length of stay was 7.2 +/- 5.4 days. Eighty-six percent of patients received no blood products. There was 1 hospital death (0.2%). Morbidity included reexploration for bleeding (4%), respiratory insufficiency (1%), stroke (1%), myocardial infarction (0.2%), and wound infection (0.2%). We conclude that virtually all mitral valve procedures, including complicated repairs, can be accomplished via partial upper sternotomy with an extended transseptal incision. This approach provides excellent exposure of the mitral valve and results in a low rate of wound complications, low transfusion requirements, and excellent cosmesis.