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Port-Access cardiac surgery: from a learning process to the standard
Ernesto Greco1, Clemente Barriuso, Miguel Angel Castro
1Institute for Cardiovascular Diseases, Cardiovascular Surgery, Barcelona, Spain. grik@eresmas.com
The Heart Surgery Forum
|July 13, 2002
Summary
Port-Access surgery, a minimally invasive cardiac technique, proved safe and effective in 129 patients. This video-assisted approach with minimal thoracotomy achieved standardized results for various cardiac procedures, including mitral valve surgery.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
- Thoracoscopic Surgery
Background:
- Port-Access surgery represents an innovative yet controversial minimally invasive technique for cardiac operations.
- It has been widely adopted for treating diverse cardiac conditions.
- The study aimed to assess the efficacy and safety of Port-Access surgery in achieving standardized outcomes without increased risk.
Purpose of the Study:
- To evaluate the safety and reproducibility of the Port-Access technique in cardiac surgery.
- To determine the efficacy of this minimally invasive approach for various cardiac procedures.
- To assess the feasibility of Port-Access surgery in high-risk patient populations.
Main Methods:
- Utilized endovascular cardiopulmonary bypass (CPB) via femoral access and endoluminal aortic occlusion in 129 patients.
- All procedures were video-assisted, employing a minimal anterior thoracotomy (4-6 cm) as the surgical approach.
- The study encompassed a range of surgical interventions, including mitral valve surgery, atrial septal defect repair, and atrial tumor removal.
Main Results:
- Over 96% of planned cases were successfully completed as true Port-Access procedures.
- Mean CPB and cross-clamp times were 87.2 min and 54.9 min, respectively.
- Overall hospital mortality was 1.5%, with a 2.2% rate for mitral valve surgery. Early neurological events occurred in 0.7% of patients. Mean extubation time was 5 hours, ICU stay 12 hours, and total hospital stay 7 days.
Conclusions:
- The Port-Access technique is a safe and reproducible method for cardiac surgery, utilizing a limited surgical approach.
- It is particularly advantageous for specific procedures like isolated primary or redo mitral surgery, ASD repair, and atrial tumor excision.
- The technique is especially beneficial for high-risk patients, including the elderly and those requiring reoperation, although further simplification is desirable.