Minimally invasive cardiac surgery using the heartport technique

Background: Minimally invasive cardiac surgery has been developed in part as a result of progress in video-assisted and endovascular surgical techniques. Port-access cardiac surgery, which provides cardiopulmonary bypass, cardioplegic arrest, myocardial protection, and ventricular decompression, permits various procedures to be performed through smaller, less invasive incisions. Methods: Proper patient selection is emphasised in order to minimise potential complications with the port-access system. For port-access coronary revascularisation procedures, a limited left anterior thoracotomy allows harvesting of the internal mammary artery and access to the target coronary arteries. The ascending aorta can be exposed for placement of vein grafts. For port-access mitral valve surgery, a limited right thoracotomy provides direct visualisation of the left atrium and the mitral valve. Results: The feasibility and efficacy of port-access coronary revascularisation and mitral valve surgery have been demonstrated in experimental and clinical settings. Peripheral cardiopulmonary bypass with cardioplegic arrest has been reproducibly achieved based on indices of cardiac function. Port-access multivessel coronary revascularisation and port-access mitral valve procedures have been performed with acceptable results. Conclusions: The port-access catheter system effectively achieves peripheral cardiopulmonary bypass, aortic occlusion, cardioplegia delivery, and left ventricular decompression. Alternative, less invasive methods of coronary revascularisation and various intracardiac procedures can be performed without a conventional median sternotomy.