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ISSN: 1895-4588
Videosurgery and Other Miniinvasive Techniques
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2/2019
vol. 14
 
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abstract:
Original paper

Pilot study of totally thoracoscopic periareolar approach for minimally invasive mitral valve surgery. Towards even less invasive?

Marcin Maruszewski
,
Radosław Smoczyński
,
Mariusz Kowalewski
,
Maciej Bartczak
,
Anna Witkowska
,
Jakub Staromłyński
,
Dominik Drobiński
,
Mariusz Kujawski
,
Piotr Suwalski

Videosurgery Miniinv 2019; 14 (2): 326–332
DOI: https://doi.org/10.5114/wiitm.2019.81663
Online publish date: 2019/01/22
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Introduction
Minimally invasive mitral valve surgery (MIMVS) has become a widely accepted alternative to the standard sternotomy approach for treatment of mitral valve (MV) disease. Because the extent and location of mini-thoracotomies employed for MIMVS vary from center to center, the conclusions regarding superior cosmesis are not generalizable. The totally thoracoscopic periareolar (TTP) – MIMVS technique has been used at our department for minimally invasive cardiac surgery since 2015.

Aim
To report early surgical data as well as mid-term outcomes in patients undergoing TTP-MIMVS.

Material and methods
Between 2015 and 2017, 48 consecutive patients (mean age: 65.4 ±10; 83% men; EuroSCORE II: 5.1 ±4%) underwent TTP-MIMVS due to mitral and mitral/tricuspid valve (TV) disease; patients’ demographics and clinical outcomes were prospectively collected. Kaplan-Meier estimates of survival and freedom from re-intervention were analyzed as well.

Results
Mean follow-up was 1.7 (max 2.5) years. Of 48 patients, 33 (69%) underwent isolated MV repair, 4 (8%) isolated MV replacement and 11 (23%) MV/TV repair. The cardiopulmonary bypass and aortic cross-clamp time was 166 ±70 and 103 ±39 min respectively. There was no conversion to either full sternotomy or a mini-thoracotomy approach. Median (interquartile range) duration of intensive care unit stay was 1.2 (1.0–2.0) days. There was one in-hospital death (2.1%) in the TTP-MIMVS group. No strokes or wound infections were observed. Within the investigated follow-up, the freedom from reoperation rate was 96.4%; remote survival was estimated at 96.9%.

Conclusions
The study proved that TTP-minimally invasive surgery was safe and feasible in mitral and tricuspid valve surgery. It has been associated with superior esthetics. Mitral repairs performed through TTP access are durable in mid-term observation.

keywords:

minimally invasive surgery, mitral valve, extracorporeal circulation, periareolar access, valvular disease
  
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