Minimally Invasive Surgery
A New Standard

Minimally invasive heart surgery using the Port-Access system is now the preferred approach at NYU Medical Center for a wide range of patients and procedures, including multi-vessel bypass and valve surgery," according to Stephen Colvin, MD, Chief of Cardiothoracic Surgery. Three years of experience and careful evaluation of data suggest that Port-Access surgery is as safe and effective as open-chest procedures, and provides significant advantages for a substantial proportion of patients. These include reduced pain, accelerated recovery , shortened hospital stay, markedly decreased scarring, and quicker return to work. This surgical method is a major departure from the traditional approach to cardiac surgery, because it is performed without a sternotomy.

For valve surgery, Port-Access had an operative mortality rate of 3.3% for replacements and 1.5% for repairs, while the open-chest results were 5.3% and 2.3%, respectively. Port-Access and open-chest procedures carried similar risks of stroke and heart attack, while post-op atrial fibrillation was significantly lower in the Port-Access patients (5% vs. 17% for bypass, and 7% vs. 24% for valve procedures).

Clinical Evalulation

Port-Access minimally invasive heart surgery has been studied carefully in a series of steps, according to Aubrey Galloway, MD, Director of Surgical Research at NYU. This assessment began with animal studies, followed by small clinical trials. Our experience in those trials was very positive. Post-operative catheterization of bypass patients during our first year showed overall graft patency of 98% Ñ equivalent to the best of open-chest surgery. Among valve surgery patients, echocardiograms demonstrated restored valve function in 98.5% of cases.Recently, in a prospective study at 121 institutions, based on over 1000 procedures included in the Port-Access International Registry, Port- Access achieved results at least as good as open-chest heart surgery for coronary bypass and valve procedures. Operative mortality for Port-Access bypass was 1%, compared to 2.9% for the open-chest procedure.

Origins

The idea that cardiopulmonary bypass (CPB) and cardiac surgery could be performed without opening the chest by using specially designed devices was developed by John Stevens, MD, when he was a surgical resident at Stanford University. After completing his residency, Dr. Stevens formed Heartport, Inc., to test this idea by developing the system known as Port-Access. NYU cardiac surgeon Greg Ribakove, MD, first learned about the Port-Access system at Stanford University and later introduced it to other surgeons at NYU. Dr. Galloway recalls, "We got involved very early in the techniqueÕs development, doing pre-trial research to prove safety and short-term efficacy within our own institution."