ISMICS 17 Annual Scientific Meeting, 7-10 June 2017, Rome Cavalieri, Rome, Italy
ISMICS 17 Annual Scientific Meeting, 7-10 June 2017, Rome Cavalieri, Rome, Italy
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Early Outcome Of Fully 3d Endoscopic Mitral Surgery
Takahiro Takemura, Hirokazu Niitsu, Gentaku Hama, Yasuyuki Toyota, Yasutoshi Tsuda.
Saku Central Hospital Advanced Care Center, Saku, Japan.

OBJECTIVE: Minimally invasive mitral valve surgery has s significant advantages of minimizing surgical trauma. This procedure is a wildly used technique with endoscopic assist. However robotic assist is used for totally endoscopic procedure in many institution. We performed fully 3D endoscopic procedure through 5-7cm right mini-thoracotomy without rib spreading and robotic assist from January 2013. We present the results of our early experience.
METHODS: From January 2013 to November 2016, a total of 35 patients underwent full 3D endoscopic mitral repair for severe degenerative mitral regurgitation or functional mitral regurgitation. The procedure was performed 5cm skin incision in male patients and 7cm inframammary skin incision in female patients using soft tissue retractor. And 11mm endoscopic port, 5mm thoracic port and trans thoracic aortic clamp were used.
RESULTS: The 3D totally endoscopic procedures were successful in 31 patients. Full sternotomy conversion was experienced in 1 patient. Mean cardiopulmonary bypass time and cross clamp time were 251 minutes and 141 minutes, respectively. Resection techniques for posterior leaflet (PML) was performed in 9 patients and chordal replacement for PL was performed in 8 patients. Chodal replacement for anterior leaflet was performed in 6 patients and resection technique for AML was performed in 1 patient. Combined procedure for both leaflets underwent in 3 patients. Ring annuloplasty was combined with those procedures in all patients. 3 patients underwent annuloplasty alone. Endocardial surgical Cox-Maze ablation for left atrium using pen type radiofrequency device was performed in 6 patients with persistent atrial fibrillation. There was no mortality and no re-exploration due to bleeding. 1 patient underwent mitral valve replacement 11day after first operation. 28 patients had no or trivial mitral regurgitation and 2 patients had mild regurgitation at discharge. 1 patients required re-operation due to recurrence of moderate regurgitation and 1 patients required due to hemolysis 2 month after operation.
CONCLUSIONS: We performed standard mitral valve repair techniques using 3D endoscope with good visualization. This procedure is safe and cost effective technique compared with robotic mitral surgery.


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