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SHIFTING FROM MINIMALLY INVASIVE TO PERIAREOLAR ENDOSCOPIC ACCESS FOR MITRAL VALVE SURGERY
Giacomo Bianchi, Rafik Margaryan, Marco Solinas.
Ospedale del Cuore - Fondazione Toscana "G. Monasterio", Massa, Italy.

OBJECTIVE: to evaluate performance of a well established minimally invasive cardiac surgery program using single incision minimally invasive mitral valve surgery (sMIMVS) shifting to endoscopic mitral surgery with periareolar access.
METHODS: from July 2015, 23 patients (male 86%) underwent endoscopic mitral surgery with periareolar access in men or a 2 cm incision in the submammary groove in women. We evaluated the timing of surgical steps of endoscopic approach and compared retrospectively with 38 patients (male 47%) that underwent sMIMVS from May 2015 from the same surgical team.
RESULTS: time from skin incision to heparin was significantly lower in endoscopic approach (18.3±6.1 vs 23.1±8.5; p=0.03), while no differences where found in cannulation time (p=0.65); interestingly, time to cross-clamp was higher in endoscopic approach (27±10.6 vs. 13.3± 6.7; p <0.01). Cardiopulmonary bypass and aortic cross clamp were significantly longer in endoscopic approach (154±36 vs 117±40; p<0.01 and 98±25 vs. 74±26; p<0.01). No differences where found in mechanical ventilation time (6 hours vs 5 hours; p=0.42) and intensive care unit stay (1.3±0.7 days vs. 1.4±1.1 days; p=0.67), while hospital length of stay equal or less than 6 days is in favour of endoscopic access (78% vs. 58%; p<0.01). Convertion to sternotomy occurred in 1 patient in the endoscopy group and in 2 patients in the sMIMVS group (p=NS); no convertion occurred due to poor exposition or difficulties in mitral valve repair. There was 1 in-hospital death in the sMIMVS group (p=NS).
CONCLUSIONS: while initial experience with endoscopic mitral valve surgery is associated with prolonged CPB and cross-clamp time, these did not affected the outcome, reducing the hospital length of stay and ensuring equal repair rate of a well established sMIMVS.


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