The Nipple-cut Approach In Minimally Invasive Mitral Valve Repair Surgery: A Feasible, Safe And Cosmetic Appealing Technique
Karel M. Van Praet.
German Heart Center Berlin, Berlin, Germany.
Objective: Minimally invasive mitral valve repair (MIS-MVR) has evolved to a routine procedure in specialized centers. The most widely used MIS-MVR approach is performed through a right anterolateral minithoracotomy mostly under direct vision. In this study we aim to report our early experience of an endoscopic nipple-cut access approach aiming for an optimal cosmetic result.
Methods: From 11/2015-10/2016 a nipple-cut approach was performed in 30 male patients (mean age 60.4 years, EuroSCORE 4.2%, EuroSCORE-II 1.0%, STS-PROM 0.6%). Twenty-five patients (83%) presented with prolapse including anterior and/or bi-leaflet disease, four patients (14%) with functional MR and left atrial myxoma was found in one patient (3%). All procedures were performed in a non-rib-spreading-manner with 3D-endoscopic visualization and X-clamping was achieved using the endo-balloon-technique. To objectively assess the cosmetic result, a battery of patient questionnaire tests, commonly used in aesthetic surgery, was utilized (Vancouver Scar Scale-VSS, Manchester Scar Scale-MSS, Patient Scar Assessment Scale-PSAS, Dermatology Quality of Life Index-DQLI, Stony Brook Scar Evaluation Scale-SBSES). The median time from surgery to scar assessment was 216 days.
Results: MV repair was successful including a full semi-ridgid-annuloplasty-ring and neo-chordae in case of MV prolapse. A concomitant cryo-ablation was performed in 4 patients (14%) and in one case tricuspid valve annuloplasty was done. Mean procedure-, CPB- and X-clamp-time were 172±23.03, 112±16.51 and 70±7.45 minutes respectively. Conversion to a minithoracotomy or sternotomy was not required in any cases. Postoperatively, no stroke or other MACCE events were observed. Follow-up was complete with 100% overall survival. Total scar assessment scale scores are depicted in Figure 1.
Conclusion: The endoscopic Nipple-Cut approach proved to be safe and reproducible and even allows for complex mitral valve repair or additional tricuspid procedures. The scar assessment battery (cosmetic result, sensory function) demonstrated high patient satisfaction.
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