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OBJECTIVE: To investigate the feasibility and safety of totally thoracoscopic replacement of mitral valve through three ports in right chest.
METHODS: Totally thoracoscopic mitral valve replacement (MVR) was performed in 62 patients (27 males; mean age 51.7±5.6 years). An additional 36 patients undergoing open-chest MVR were selected as a control group. Through three port incisions in the right chest, pericardiotomy, bicaval occlusion, atriotomy, MVR were performed by a thoracoscopy without the aid of a robotically-assisted surgical system.
RESULTS: The cardiopulmonary bypass and aortic crossclamp times were 62.2±9.8 and 41.5±7.3 min, respectively. There was no mortalities. The intensive care unit (14.1±4.5 vs 24.5 ± 5.6 hours, P <0.01) or postoperative hospital stays (6.5±1.8 vs 8.6± 2.1 days, P <0.05) in the thoracoscopic group were shorter than in the control group. The percentage of patients who required postoperative opioid analgesics in the thoracoscopic group was lower than in the control group (21.0% vs 75.0%, P <0.01). Rate of blood transfusion during the operation in the thoracoscopic group was also lower than in the control group (17.7% vs 69.4%, P =0.001). Transesophageal echocardiographic analysis 5.2 ± 3.9 months after the operation showed improved heart function and normal prosthesis.
CONCLUSIONS: Totally thoracoscopic MVR through a 3-port entry without the aid of a robotically-assisted surgical system appears to be safe and effective.