International Society For Minimally Invasive Cardiothoracic Surgery

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Three Port Totally Endscopic Mitral Valve Surgery :Propensity Matched Comparison With Conventional Sternotomyapproach
Masayoshi Tokoro, Toshiaki Ito, Atsuo Maekawa, Sadanari Sawaki, Junji Yanagisawa, Takahiro Ozeki, Mamoru Orii, Toshiyuki Saiga.
Japanese Red Cross Nagoya First Hospital, Nagoya City, Aich Pref., Japan.

Objective: In 2010, we began endoscopic minimally invasive mitral valve surgery(MI-MVS) through three-ports (one incision plus two-port), and subsequently reported its technical aspects and initial results. The aim of this study was to compare the safety and invasiveness of three-port totally endoscopic MI-MVS with those of conventional mitral valve surgery (C-MVS). Methods: Surgery: The patient was set in partial left lateral position and cardio-pulmonary bypass was established through the right groin. A small thoracotomy was made through the right axillary skin incision. All procedures were performed using three-dimensional endoscope. Comparison with C-MVS: Between January 2009 and November 2017, Total of 773 patients underwent mitral valve surgery. 491 cases (without combined aortic valve, coronary or aortic surgeries) were enrolled in this study. Of them, 342 underwent MI-MVS, 149 underwent C-MVS. Propensity matching between MI-MVS and C-MVS patients generated 142 matched pairs. Early outcomes were compared in these 284 patients. Primary endpoints were major adverse cardiac and cerebrovascular events(MACCE). Secondary endpoints were post-operative length of ICU and hospital stay. Results: After matching, there were no longer any significant differences in background. Four patients (1.1%) was converted to sternotomy due to the uncontrollable bleeding. There was significantly much number of the MACCE in MI-MVS (MI- vs C-MVS:7 vs 20, P<0.01). ICU stay and postoperative hospitalization were shorter in MI-MVS group (MI- vs C-MVS:1.51.3 vs 2.52.7days, p<0.01 and 10.66.5 vs 17.011.2days, p<0.01, respectively). Cardio-pulmonary bypass time and Aorta cross-clamp time were significantly longer in MI-MVS (MI- vs C-MVS: 17749 vs 15053min, p<0.01 and 12251 vs 10342min, p<0.01, respectively) but there was no significant difference between two groups in Surgery time (MI- vs C-MVS: 25664 vs 26681min, p=0.37). Conclusions: Propensity-matched comparison between MI-MVS and C-MVS showed significantly lower MACCE rate in MI-MVS. Three-port totally endoscopic MI-MVS was at least as safe as C-MVS, and seemed to be less invasive because of its shorter postoperative course.


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