Comparison Of Video-assisted Minithoracotomy And Totally Thoracoscopic Periareolar Approach For Minimally Invasive Mitral Valve Surgery
Radoslaw Smoczynski1, Grzegorz Suwalski2, Jakub Staromlyński1, Anna Witkowska1, Dominik Drobinski1, Wojciech Sarnowski1, Irena Walecka1, Piotr Suwalski1.
1Central Teaching Hospital MSW, Warsaw, Poland, 2Military Institute of Medicine Central Clinical Hospital Ministry of National Defence, Warsaw, Poland.
OBJECTIVE: Minimally invasive technique for mitral valve surgery is widely accepted approach with well proven benefits in comparison to standard full sternotomy access. Totally thoracoscopic periareolar (nipple-cut) access is a new access through natural scar in the body around nipple. The interesting scientific question is if the new method is at least comparable with the minithoracotomy, and it could be promoted not only as better cosmetics results.
METHODS: The study involved 175 consecutive patients operated due to mitral valve and optionally tricuspid valve disease with use of minimally invasive technique. First 130 patients were operated via right sided video-assissted(V-A) minithoracotomy and the second group (45 patients) consecutively with new totally endoscopic approach. Primary endpoint of the study consisted of in-hospital death, stroke, need for chest revision due to bleeding, need for mechanical circulatory support and extended mechanical ventilation. Secondary outcomes consisted of aortic cross clamp time, need for conversion to full sternotomy, need to conversion to thoracothomy in totally endoscopic approach group, need for transfusion, need for inotropes use, wound infection or delayed healing requiring surgical intervention, time of in-hospital stay.
RESULTS: There was no difference in terms of in-hospital mortality between totally thoracoscopic group (1 patient; 2,1%) and video-assisted minithoracotomy group (3 pts., 2.3%, p=ns). Stroke occurred in 3 (2.3%) patients from V-A minithoracotomy group and in none from totally endoscopic group (p=ns). There was non difference in average postoperative mechanical ventilation time between studied group: 7.6 (+/-8 hours) in totally thoracoscopic group versus 8 (+/- 42 hours) in V-A minithoracotomy group (p=ns). In none of the patient there was a conversion to full sternotomy required. No conversion from a totally thoracoscopic approach to V-A minithoracotomy approach to was needed. There was no significant difference in average blood loss during first postoperative day between totally thoracoscopic group (445 +/- 308 ml) and V-A minithoracotomy population (433 +/- 315 ml; p=ns).
CONCLUSIONS: Totally thoracoscopic technique for mitral valve surgery is feasible in consecutive male and in selected female patients. The study proved equal safety of thoracoscopic approach in comparison to standard minithoracotomy video-assisted access in mitral valve surgery.
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