A Matched Pairs Analysis Of Totally Endoscopic Versus Mini-thoracotomy For Mitral Valve Surgery
Giacomo Bianchi, MD, PhD, Rafik Margaryan, MD, PhD, Marco Solinas, MD.
Ospedale del Cuore - Fondazione Toscana "G. Monasterio", Massa, Italy.
OBJECTIVE: Minimally invasive valve surgery through right thoracotomy has become the preferred access for mitral valve surgery; video-assisted technology also developed to allow a complete endoscopic surgery. The aim of this paper is to compare standard right mini-thoracotomy (sRMT) with an endoscopic non-rib spreading (eNRS) approach regarding feasibility, safety and functional results.
METHODS: A matched pair analysis was undertaken of retrospectively collected 286 patients that underwent mitral valve surgery from January 2010 to November 2016. Eighty-six patients with a sRMT procedure were compared with 86 patients with an eNRS endoscopic operation. In sRMT group the access was a 5-6 cm incision in the inframmamary fold through the fourth intercostal space with the insertion of a rib spreader; in the eNRS group the access was periareolar in men, while in women it was a 3 cm incision in the inframammary fold; in eNRS group only soft-tissue protector was used.
RESULTS: The procedures were successful in all patients; 30-days mortality was 0% in both groups. Duration of anesthesia and overall procedure did not differ. Cardiopulmonary bypass time (CPB) and cross-clamp (X-Clamp) time were higher in the eNRS group: 146±27 min vs. 122±28 min (p<0.001) and 92±20 min vs. 79±18 min (p<0.001). This did not affected the overall repair rate (94% vs. 88%, eNRS vs. sRMT; p=0.17). Hospital stay was shorter in the eNRS group (6 days vs. 7 days, eNRS vs. sRMT; p=0.19) with an higher rate of home discharge (95% vs. 88%; p<0.05). Patient satisfaction was higher in the eNRS group.
CONCLUSIONS: Endoscopic mitral valve surgery is safe, reproducible and yeld comparable results with standard minimally invasive mitral valve procedure; higher CPB and X-Clamp time are part of the learning curve, but did not affected the operative results nor impacted on early mortality. Recovery and return to home rate was higher in the eNRS group, as well as cosmetic satisfation.
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