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Non-Rib-Spreading, 3D Fully Endoscopic, Mini Incision Technique vs. Conventional Mini-Thoracotomy for Mitral Valve Repair - a Matched Pair Analysis
Fiona S. Westhofen, Lenard Conradi, Christian Detter, Tobias Deuse, Hermann Reichenspurner, Hendrik Treede.
University Heart Center Hamburg, Hamburg, Germany.

OBJECTIVE: Looking back over the last few years, there has been a progressive development in the field of minimally invasive mitral valve surgery (MIMVS), and a fully endoscopic access through a 3-4 cm right lateral mini-thoracotomy without rib-spreading has nowadays been established as the standard approach at our institution. We report about a case series of non-rib-spreading minimally invasive mitral valve repair, achieving optimal visualization through fully 3D endoscopic technique.
METHODS: MIMVS is routinely performed at our institution - up to now in 788 patients. Since June 2014, 20 patients underwent 3D fully endoscopic mitral valve repair through the right fourth intercostal space. The 3D endoscope is placed dorsal to the 3 cm long incision. It enables precise spatial representation of the valve, and facilitates better orientation for the surgeon. Patient and surgical data, early postoperative outcomes and repair results were analyzed. The mitral valve reparative techniques included triangular posterior leaflet resection, leaflet sliding plasty, and ring annuloplasty. Chordal replacement is also a routinely performed standard repair mechanism in these patients.
RESULTS: The3D fully endoscopic procedures were successful in all patients without technical limitations. Mortality was 0% and there were no perioperative or postoperative complications. There was no incidence of new atrial fibrillation, wound infection, myocardial infarction or stroke. Postoperative echocardiography showed sufficient repair in all patients. Mean operation time was 275 ± 49 minutes, CPB time was 209 ± 48 minutes and ACC time was 129 ± 31 minutes. Patient left ICU after 1.6 ± 0.9 days and stayed hospitalized for 6.5 ± 1.6 days.
CONCLUSIONS: 3D fully endoscopic NRS-MIMVS creates an improved visualization and orientation for the operating surgeon. In our first case series we could prove that an optimal valve repair is possible without any complications. Especially for complex reconstruction cases, the 3D visualization offers detailed guidance, allowing perfect placement of neo-chordae.The procedure is feasible and safe, and shows no limitations in surgical repair techniques.


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