Non-rib-spreading Totally Endoscopic Mitral Valve Repair Using 3 Dimensional Camera
Saku Central Hospital, Saku, Japan.
Minimally invasive cardiac surgery (MICS) for mitral valve repair has been performed successfully over the past decade. However postoperative pain related to rib-spreading violates the value of MICS. Although robot-assisted mitral valve repair is one of the least invasive way, it has been limited by the cost involved. We review the early resuls of our totally endoscopic procedure using the 3D camera(SHINCO OPTICAL Co. ltd, Tokyo, Japan).
From January 2013 to December 2015, 27 patients underwent totally 3D endoscopic mitral repair for severe degenerative mitral regurgitation or functional mitral regurgitation. Under general anesthesia with one-lung ventilation, a right anterior minithoracotomy in the 4th intercostal space is made. We use soft tissue retractor without rib spreader. The 3D camera is inserted laterally in the same space. CPB is established with femoral(axillary) cannulation. The ascending aorta is cross-clamped with transthoracic clamp.
The procedures were successful in all patients. Mean cardiopulmonary bypass time and cross clamp time were 152±40 minutes and 99±23 minutes, respectively. Resection techniques performed in 10 patients and chordal replacement performed in 10 patients. Combined procedure for both leaflets underwent in 3 patients. Ring annuloplasty was combined with those procedures in all patients. 2 patients underwent annuloplasty alone. Endocardial surgical Cox-Maze ablation for left atrium using pen type radiofrequency device was performed in 6 patients with persistent atrial fibrillation. No patients required conversion to
sternotomy. There was no mortality and no re-exploration due to bleeding. All patients had no severe operative pain. 23 patients had no or trivial mitral regurgitation and 2 patients had mild regurgitation at discharge. 1 patient required re-operation due to recurrence of moderate regurgitation and 1 patient required due to hemolysis 2 month after operation.
Based on our experience, Non–Rib-Spreading totally 3D endoscopic mitral valve repair provides effective and relatively painless treatment without robotic assistant.
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