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Video-assisted Minimally Invasive Cardiac Surgery: A 10-year, Single Center Experience
Jae Suk Yoo, Joon Bum Kim, Sung Ho Jung, Suk Jung Choo, Cheol Hyun Chung, Jae Won Lee.
University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea, Republic of.

OBJECTIVE: To review a 10-year, single center experience with video-assisted minimally invasive cardiac surgery (MICS).
METHODS: A retrospective analysis was performed on all patients who underwent video-assisted MICS between December 2002 and October 2012.
RESULTS: A total of 826 patients included 583(70.6%) mitral valve surgeries and other cardiac surgeries (Table), of which 90(10.9%) had underwent previous sternotomy. MICS approach involved a 4-or 6-cm right thoracotomy (except for MIDCABs and some VSD closures via left thoracotomy) and cardiopulmonary bypass conducted through femoral vessels and/or jugular vein. Mean bypass and cross-clamping time was 130.5±50.2 and 80.0±34.6 hours. There were 5(0.6%) 30-day deaths (4 from mitral valve replacement and 1 from myxoma excision). Postoperative complications included 32(3.9%) postoperative bleeding, 11(1.3%) newly-required dialysis, 6(0.7%) permanent stoke, 4(0.5%) low cardiac output, 5(0.6%) pneumonia, and 8 (1.0%) minor wound problem. There was only one(0.1%) intraoperative conversion to sternotomy, which was due to bleeding. Among patients who underwent mitral valve repair, mid- and long-term follow-up was possible in 314 patients (MR in 96.8%, MS in 3.1%, anterior leaflet involvement in 36.0%, rheumatic etiology in 10.8%). Of them, various repair techniques including annulopasty (95.9%), commissuroplasty (23.2%), neochordae formation (33.1%), leaflet resection (40.8%), leaflet plication/extension (7.6%), chordal transfer/shortening (4.1%), edge-to-edge (3.5%) were utilized, with no/trivial or mild residual MR in 95.2% of patients. The median follow-up was 50.2 months, during which freedom from MR (>mild) at 5 years was 84.3%, and freedom from major adverse event or death at 5 years was 92.5%. Reoperation for mitral valve problem occurred in 8 (2.5%) patients (6 recurred MR, 1 MS, 1 infective endocarditis).
CONCLUSIONS: A video-assisted MICS is safe with low mortality and morbidity. It is also feasible in mitral valve repair in terms of utilizing various types of repair techniques and the efficacy of repair.
Surgical procedure details.
Mitral valve surgery583 (70.6%)Repair 353 (60.5%)Replacement 231 (39.5%)
Atrial septal defect closure99 (12.0%)
Myxoma excision40 (4.8%)
MIDCAB40 (4.8%)
Isolated tricuspid valve surgery35 (4.2%)Repair 14 (40.0%)Replacement 21 (60.0%)
Ventricular septal defect closure20 (2.4%)
Isolated atrial fibrillation ablation6 (0.7%)
Aortic valve replacement2 (0.2%)
Septal myectomy1 (0.1%)
Concomitant proceduresTricuspid repair 119 (14.4%)Maze 249 (30.1%)



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