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Minimally invasive mitral valve replacement: port-access technique, feasibility, and myocardial functional
D S Schwartz1, G H Ribakove, E A Grossi
1Department of Surgery, New York University Medical Center, New York 10016, USA.
Objective:
This experiment examined the feasibility of minimally invasive port-access mitral valve replacement via a 2.5 cm incision.
Methods:
The study evaluated valvular performance and myocardial functional recovery in six mongrel dogs after port-access mitral valve replacement with a St. Jude Medical prosthesis (St. Jude Medical, Inc., St. Paul, Minn.). Femoro-femoral cardiopulmonary bypass and a balloon catheter system for myocardial protection with cardioplegic arrest (Heartport, Inc., Redwood City, Calif.) were used. The mitral valve was replaced through a 2.5 cm port in the left side of the chest, and the animals were weaned from bypass. Cardiac function was measured before and at 30 and 60 minutes after bypass. Left ventricular pressure and electrical conductance volume were used to calculate changes in load-independent indexes of ventricular function.
Results:
Each procedure was successfully completed. Recovery of left ventricular function was excellent at 30 and 60 minutes after bypass compared with the prebypass values for elastance (30 minutes = 4.04 +/- 0.97 and 60 minutes = 4.27 +/- 0.57 vs prebypass = 4.45 +/- 0.96; p = 0.51) and for preload recruitable stroke work (30 minutes = 76.23 +/- 4.80 and 60 minutes = 71.21 +/- 2.99 vs prebypass = 71.23 +/- 3.75; p = 0.45). Preload recruitable work area remained at 96% and 85% of baseline at 30 and 60 minutes (p = not significant). In addition, transesophageal echocardiography demonstrated normal prosthetic valve function, as well as normal regional and global ventricular wall motion. Autopsy revealed secure annular-sewing apposition and normal leaflet motion.
Conclusions:
These results suggest that minimally invasive mitral valve replacement using percutaneous cardiopulmonary bypass with cardioplegic arrest is technically reproducible, achieves normal valve placement, and results in complete cardiac functional recovery. Minimally invasive mitral valve replacement is now feasible, and clinical trials are indicated.
Insights
Minimally invasive mitral valve replacement using a small incision is feasible and technically reproducible. This procedure demonstrated excellent cardiac functional recovery and normal prosthetic valve function in a canine model.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Procedures
- Prosthetic Valve Technology
Background:
- Mitral valve replacement is a critical cardiac procedure.
- Minimally invasive approaches aim to reduce surgical trauma and improve recovery.
- Port-access techniques offer potential advantages over traditional sternotomy.
Purpose of the Study:
- To evaluate the feasibility of minimally invasive mitral valve replacement through a small, 2.5 cm port-access incision.
- To assess valvular performance and myocardial functional recovery following the procedure.
Main Methods:
- The study involved port-access mitral valve replacement in six mongrel dogs using a St. Jude Medical prosthesis.
- Femoro-femoral cardiopulmonary bypass and a balloon catheter system for myocardial protection with cardioplegic arrest were employed.
- Cardiac function was measured pre- and post-procedure using left ventricular pressure and electrical conductance volume.
Main Results:
- All procedures were successfully completed with excellent recovery of left ventricular function.
- Transesophageal echocardiography confirmed normal prosthetic valve function and ventricular wall motion.
- Autopsy showed secure valve placement and normal leaflet motion.
Conclusions:
- Minimally invasive mitral valve replacement via port-access is technically reproducible and safe.
- The procedure achieves normal valve placement and complete cardiac functional recovery.
- Clinical trials are warranted to translate these findings to human patients.