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Three ports thoracoscopic techniques for mitral valve replacement without robotically assisted surgical system: technical challenges and solutions
zengshan ma, Sr., hourong sun.
Shandong Unversity, Ji'nan, China.

OBJECTIVE: To investigate the feasibility and safety of totally thoracoscopic MVR through three ports in right chest.
METHODS: 262 patients with rheumatic heart disease were selected from Cardiac Surgery of our hospitals, 157 males; mean age 51.7±5.6 years; mean body weight was 69.8± 8.7 kg) . An additional 36 patients undergoing open-chest MVR were selected as a control group. Using 3 port incisions in the right chest, pericardiotomy, bicaval occlusion, atriotomy, and MVR were performed by thoracoscopy without the aid of a robotically assisted surgical system.
RESULTS: The cardiopulmonary bypass and aortic crossclamp times were 62.2±9.8 and 46.5±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 75.2%, P <0.01). Rate of blood transfusion during the operation (17.6% vs 69.8%, P =0.001). Transesophageal echocardiographic analysis 5.2 ± 3.9 months after the operation showed heart function improved and prosthesis was normal.
CONCLUSIONS: Three ports thoracoscopic techniques for MVR by totally thoracoscopic is safe and effective. This technique is associated with a reduced intensive care, the rate of blood transfusion during the operation and hospital stay in comparison with conventional MVR.

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