3d Thoracoscopy Correlates With Shorter Cross-clamp Time Among Patients Undergoing Periareolar Minimally Invasive Mitral Valve Repair
Radoslaw Smoczynski, Jakub Staromlynski, Anna Witkowska, Dominik Drobinski, Wojciech Sarnowski, Irena Walecka, Dariusz Kosior, Piotr Suwalski.
Central Teaching Hospital, Ministry of Interior, Warsaw, Poland.
Backgroud Three-dimensional (3D) thoracoscopic technology is innovative approach to minimally invasive mitral valve surgery. The study investigates hypothesis if the 3D thoracoscope could improve surgical outcomes in periareolar mitral valve repair. Methods 58 consecutive patients, who underwent periareolar totally thoracoscopic mitral valve repair were included in the study. Surgical technique was based on mitral ring implantation alone or ring annuloplasty combined with Gore-Tex loop implantation. In addition, two types of thoracoscopes were used: 2D and 3D vision system. Intraoperative data collected included cross-clamp time and cardio-pulmonary bypass time. Early postoperative outcomes were reviewed. Results All procedures were performed through periareolar incision around the nipple without conversion to minithoracotomy or sternotomy. 3D vision was used in 24 patients and 2D vision in the remaining cases. Significantly shorter cross-clamp time was observed among patients who underwent 3D-assisted Gore-Tex loop implantation combined with ring annuloplasty in comparison to 2D thoracoscopic assistance (98,6±32,7 vs. 114,5±29,2 min; p=0.04). On the other hand, patients with simple ring implantation assisted by 3D thoracoscope did not differ in terms of cross-clamp time in comparison to 2D thoracoscope assistance (71,6±13,7 vs. 88,5±45,9 min; p=0.34 ). The same correlation to cardio-pulmonary bypass time was observed. 3D vision system did not influence postoperative course as drainage, TIA/stroke, ICU stay. One death (2,9%) occurred in 2D vision group vs. none in 3D vision group (p=0.45). Conclusion 3D thoracoscopic technology reduces cross-clamp time and cardiopulmonary bypass time in complex mitral valve repair with Gore-Tex loop implantation. The reduction of intraoperative time did not influence on early postoperative outcomes. Simple mitral ring implantation does not correlate with significant cross-clamp time reduction in totally thoracoscopic periareolar approach.
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