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Eur J Cardiothorac Surg 1999;14:274-278
© 1999 Elsevier Science NL

Less invasive approaches for closed mitral commissurotomy¹

Esat Aknc^a, Muzaffer Deertekin^b, Mustafa Güler^a, Bahadr Dalar^a, Nilgün Bozbua^a, Turan Berki^a, Cevat Yakut^a

^a Department of Cardiovascular Surgery, Kouyolu Heart and Research Hospital, stanbul, Turkey
^b Department of Cardiology, Kouyolu Heart and Research Hospital, stanbul, Turkey

Received 28 September 1997; received in revised form 18 May 1998; accepted 9 June 1998.

Corresponding author. Kouyolu Kalp ve Aratirma Hastanesi (Kouyolu Heart and Research Hospital), Kadiköy, stanbul, 81020 Türkiye. Tel.: +90 216 325 54 57; fax: +90 216 33904 41; e-mail: eakinci@superonline.com

Objective: Recently, closed mitral commissurotomy (CMC) has been reexplored due to the concepts of less invasive valvular surgery. The feasibility of closed mitral commissurotomy via port access (or limited thoracotomy) by aid transesophageal echocardiography (TEE) was investigated in this clinical study. Methods: Between August 1996 and April 1998, 42 patients (32 women, ten men with a mean age of 36.2±7.8 years) underwent less invasive CMC at the Kosuyolu Heart and Research Hospital. CMC procedure were done through a limited (12–16 cm) thoracotomy incision in 23 patients, a very limited or mini thoracotomy incision (7–8 cm) in 11 patients and port access by aid TEE in eight patients. Preoperative mean mitral valve area was calculated as 1.19±0.13 cm² and mean mitral valve gradient was measured as 14.8±3.2 mmHg. TEE provided information about the mitral valve anatomy and functions during the procedure in all patients. Results: Commissurotomy was successfully performed in all patients. In eight patients, a Tubbs dilator was inserted via port access at the 6th intercostal space from a 3-cm incision. Incision by guidance of TEE and CMC could be performed without thoracotomy in five patients. In three patients of the port access group, a very limited thoracotomy was required to perform CMC by digital guidance. Postoperative mean MVA was 2.37±0.29 cm², minimal mitral gradient was 5.3±1.7 mmHg. In eleven patients, minimal mitral regurgitation was observed. The operations and postoperative period were free of complications in all patients. Following an average 12±2.8 h intensive care unit period, all patients were discharged after an average of 3.4±0.8 days of hospitalization. Conclusion: Limited thoracotomy has less detrimental structural effects in patients. Port access by aid TEE approach to CMC may offer less invasiveness, lower cost effectiveness and be an alternative to percutaneous balloon mitral valvotomy.

Key Words: Closed mitral commissurotomy • Minimal invasive valve surgery • Port access closed mitral commissurotomy • Transesophageal echocardiography