Introduction
The concept of a minimally invasive approach for mitral valve(MV)
surgery has been initiated in the nineties by Cosgrove et al., and was
primarily based on attempts to reduce the surgical invasiveness by
limiting the incision length and avoiding a full
sternotomy1,2. Encouraged by advances in thoracic and
abdominal surgery, an endoscopic approach with thoracoscopic
visualization and use of peripheral cardiopulmonary bypass, aided to
minimize the surgical trauma3. Meanwhile, this
‘port-access’ surgery has become the preferred technique for mitral
and/or tricuspid valve surgery in many centers. Several studies pointed
repetitively to the obvious benefits as an improved cosmetic result, a
shorter hospital stay, quicker socio-economic reintegration and
decreased need for blood products, whilst the main surgical end-points
in terms of quality of mitral repair and morbidity as mortality were
commonly maintained once the inevitable learning curve has been
surpassed4-11. Hence, even in experienced hands,
port-access MV surgery is associated with longer duration of
cardiopulmonary bypass and aortic cross-clamp time, known of having an
adverse effect on postoperative morbidity and mortality due to secondary
organ dysfunction5,6,8.
The purpose of this study is to compare the clinical outcome of MV
surgery performed through port-access and conventional sternotomy in a
propensity-matched cohort, with additional focus on secondary organ
function by analysis of organ-specific biomarkers and/or other
functional outcome parameters.