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.