International Society For Minimally Invasive Cardiothoracic Surgery

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Totally Video-assisted Thoracoscopic Mitral Valve Replacement: A Comparative Study Of 3d High-definition And 2d High-definition Video Systems
xin zang, Huiming Guo.
Guangdong General Hospital, Guangzhou, China.

Backgroud: To compare performance of a three-dimensional high-definition (3D-HD) video system with a two-dimensional high-definition (2D-HD) video system in patients undergoing totally video-assisted thoracoscopic mitral valve replacement (VAT-MVR).
Methods:
We enrolled 90 patients with mitral valve disease in a single institution, from June 2013 to June 2016. VAT-MVR was performed by the same surgeon using either a 3D-HD (n = 43) or a 2D-HD (n = 47) video system with the same surgical technique. Short-term outcomes were compared between the two groups. All medical records were retrieved from a prospectively maintained database of minimally-invasive cardiac surgery.
Results:
All surgeries were successfully completed under totally thoracoscopic guidance. There were no intraoperative complications in either group. The use of 3D-HD video system reduced aortic cross-clamp time by 7 minutes (3D vs 2D: 65.74 14.32 min vs 72.67 14.67 min, p = 0.027). Cardiopulmonary bypass time, postoperative ventilation duration, length of surgical intensive care unit (SICU) stay, length of hospital stay, and major complications were similar in both groups (p > 0.05). There were no perioperative deaths in either group
Conclusions:
Compared with the 2D video system, the 3D-HD video system provided a better surgical experience with the same operative safety.

Table 1: Demographic characteristics of the 3D and 2D VAT-MVR groups
3D VATS (N=43)2D VATS (N=47)p value
Age (y)51.0414.1450.6214.070.888
Gender0.818
Male12(27.9%)15(31.9%)
Female31(72.1%)32(68.1%)
Mitral Valve Pathology0.66
Rheumatic27(62.8%)32(68.1%)
Non-Rheumatic16(37.2%)15(31.9%)
LVEF(%)64.346.5664.675.970.832
LVED(mm)45.618.5049.279.110.095

LEGEND: LVEF, left ventricle ejection fraction; LVED, left ventricle end-diastolic diameter.
Table 2: Surgical Results of the 3D and 2D VAT-MVR groups
3D VATS (N=43)2D VATS (N=47)p value
CPB time (min)110.026.23116.623.930.219
ACC time (min)65.7414.3272.6714.670.027
Mechanical Ventilation Duration (h)12.318.7213.678.580.466
SICU stay(h)42.9333.5540.7229.420.742
Hospital Stay(d)8.907.848.117.260.619
Major Complications7(16.3%)6(12.8%)0.767
Death00
LEGEND: CPB, cardiopulmonary bypass; ACC, aortic cross-clamp; SICU, surgical intensive care unit.

LEGEND: Figure 1. Operating room set-up for 3DVAT-MVR, (A) 3D screen for the operator and assistant (on the left side of the patient). (B) 2D screen for the assistant (on the head side of the patient). (C) the operator and assistant wearing polarized glasses.

LEGEND: Figure 2. Skin incisions for VAT-MVR, (A) 4 cm in length, anterolateral thoracotomy at the fourth intercostal space, for the surgical instruments, cardioplegic cannula, and mitral valve prosthesis. (B): 1 cm in length, on the anteroaxillary line at the fourth intercostal space, for the thoracoscope. (C) 1 cm in length, on the midaxillary line at the fifth intercostal space, for the chi-wood aortic cross-clamp and left atrium vent. (D): 1 cm in length, on the parasternal line at the third or fourth intercostal space, for the self-retaining left atrium retractor. LEGEND: Figure 3. Patient selection and allocation of the 3D and 2D VAT-MVR groups.


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