Minimally Invasive Heart Surgery safer than open-chest procedures

New Orleans 27 January 1998 Surgeons from seven major medical centres in the USA have prepared a study on analysed data from more than thousand patients at 121 medical centres to prove that the port-access minimally invasive approach is safer and shows an equally low incidence of complications than standard open-chest procedures for both coronary bypass and mitral valve surgery. This first report issued from the Port-Access International Registry (PAIR) supports the surgeons' earlier prediction that minimally invasive heart surgery would become the standard method of dealing with bypass and valve interventions.

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Surgeons from seven major medical centres in the USA have prepared a study on analysed data from more than thousand patients at 121 medical centres to prove that the port-access minimally invasive approach is safer and shows an equally low incidence of complications than standard open-chest procedures for both coronary bypass and mitral valve surgery. This first report issued from the Port-Access International Registry (PAIR) supports the surgeons' earlier prediction that minimally invasive heart surgery would become the standard method of dealing with bypass and valve interventions.

The PAIR study recently has been presented at the annual meeting of the Society of Thoracic Surgeons. During the last two years, the port-access minimally invasive procedure is preferred by surgeons in hospitals around the world because of its reproducible results and obvious benefits to the patient, as Dr. Stephen B. Colvin, chief of cardiothoracic surgery at New York University Medical Centre, states. According to this senior author of the PAIR report, almost all valve surgery and about 30 to 50 percent of the bypass operations are performed by means of this method.

In the PAIR study, morbidity and mortality data have been compared from cases registered in the Society of Thoracic Surgeons (STS) database between mid-1995 and mid-1996, with the analysis of three different surgical approaches: 555 port-access minimally invasive coronary artery bypass grafting (CABG) procedures, 172 mitral valve replacements (MV rpl) and 127 mitral valve repairs (MV rpr). The patients were followed for nine months, starting from April 1, 1997 and evaluated with regard to the post-operative mortality criterion and to complications rates such as stroke, heart attack, abnormal heart rhythms, re-operation, renal and multi-organ failure.

The most remarkable results in the comparison were situated in the rates of new impulses of post-operative arrhytmias, which occurred in 5 to 7 percent of the port-access minimally invasive group versus 17 to 24 percent in the STS group that was studied. In general, 99 percent of the patients in the port-access coronary bypass group were still alive versus 97 percent of the STS standard open-chest patients' group. The latter group was suffering to a higher extent from advanced coronary artery disease. The authors of the PAIR study were particularly pleased to find that the positive results were spread over a wide range of centres.

The PAIR report also has proven that patients submitted to minimally invasive heart surgery, endure less pain and recover more quickly. In the future, further research will be undertaken on the measurement of long-term efficacy, quantifying recovery time and the patients' quality of life. The current results already will amount to increased use of the port-access minimally invasive procedure.


Leslie Versweyveld

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