3D Enabled Totally Endoscopic Surgery In Training Of Mitral Valve Repair
Daniel Hoefer, Herbert Hangler, Christoph Krapf, Bastian Schneider, Juliane Kilo, Michael Grimm, Ludwig Mueller.
Cardiac Surgery Innsbruck, Innsbruck, Austria.
BackgroundTo evaluate the impact of 3D totally endoscopic mitral valve repair on training, and to compare outcomes in contrast to 2D assisted minimal invasive mitral valve repair.MethodsBetween 2010 and 2017 a total number of 499 minimal invasive mitral valve procedures were performed (3D: n=154; 2D: n=345). In the totally endoscopic 3D cases a peri-areolar incision in male or submammary incision in female patients was performed. In 2D cases a 4-5 cm thoracotomy with a rib spreader to allow direct vision was used.ResultsTeaching was accompished in 78 cases of 3D surgery (51%), but only in 58 cases of 2D surgery (17%). Repair rates were higher in 3D cases than in 2D cases, as well in teaching (94% vs. 91%, p=0.23) as in the non-teaching situation (95% vs. 87%, p=0.05). 52% of all patients presented with isolated P2 prolapse, the use of neo-chords was more pronounced in 3D surgery (86% training, 76% non-training). Mean cross clamp times in the teaching situation were longer in 2D cases compared to 3D (123 vs. 119 p=0.52). Complications occurred more often in 2D cases compared to 3D teaching or 3D non-teaching situation (conversion to mitral valve replacement: 2.3% vs. 1.3% and 1.3%; residual mitral regurgitation > grade 1: 3.2% vs. 1.3% and 1.3%; revision for bleeding: 6.4% vs. 1.3% and 4.5%; 30-d-mortality: 1.7% vs. 0% and 1.3%).Conclusions3D enabled totally endoscopic mitral valve repair is safe and provides even better results than 2D assisted minimal invasive mitral valve repair. Training is feasible and more often possible in 3D cases resulting in excellent outcomes. The endoscopic view gives identical images for surgeon and assistant and therefore is an ideal tool for teaching.
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