Port-Access cardiac surgery: from a learning process to the standard

Background: Port-Access™ surgery has been one of themost innovative and controversial methods in the spectrumof minimally invasive techniques for cardiac operations andhas been widely used for the treatment of several cardiac diseases.The technique was introduced in our center to evaluateits efficacy in reproducing standardized results without anadditional risk.Methods: Endovascular cardiopulmonary bypass (CPB)through femoral access and endoluminal aortic occlusionwere used in 129 patients for a variety of surgical procedures,all of which were video-assisted. A minimal (4-6 cm) anteriorthoracotomy through the fourth intercostal space was used inall cases as the surgical approach.Results: More than 96% of the planned cases concludedas true Port-Access™ procedures. Mean CBP and crossclamptimes were 87.2 min. ± 51.2 (range of 10-457) and54.9 min. ± 30.6 (range of 10-190), respectively. Hospitalmortality for the overall group was 1.5%, and mitral valvesurgery had a 2.2% hospital death rate. The incidence of earlyneurological events was 0.7%. Mean extubation time, ICUstay, and total length of hospital stay were 5 hours ± 6 hrs.(range of 2-32), 12 hours ± 11.8 hrs. (range of 5-78), and7 days ± 7.03 days (range of 1-72), respectively.Conclusions: Our experience indicates that the Port-Access™ technique is safe and permits reproduction of standardizedresults with the use of a very limited surgicalapproach. We are convinced that this is a superior procedurefor certain types of surgery, including isolated primary orredo mitral surgery, repair of a variety of atrial septal defects(ASDs), and atrial tumors. It is especially useful in high-riskpatients, such as elderly patients or those requiring reoperation.Simplification of the procedure is nevertheless desirablein order to further reduce the time of operation and toaddress other drawbacks.