Long Term Results Of The Totally Thoracoscopic Periareolar Approach For Minimally Invasive Mitral Valve Surgery
Radoslaw Smoczynski1, Anna Witkowska1, Jakub Staromlynski1, Dominik Drobinski1, Grzegorz Suwalski2, Wojciech Sarnowski1, Irena Walecka1, Dariusz Kosior1, Piotr Suwalski1.
1Central Teaching Hospital, Ministry of Interior, Warsaw, Poland, 2Military Institute of Medicine, Warsaw, Poland.
Background: The study compares long term results of totally thoracoscopic periareolar approach (T-T) to video-assisted minithoracotomy (V-A) for minimally invasive mitral valve surgery. Methods: 178 consecutive patients were divided into two groups: periareolar (48 pts.) and video-assisted (130pts.) approach. A primary indication for surgery was: the isolated mitral valve regurgitation in 81.2% of the patients, mitral valve stenosis in 18.8% of the patients and the concomitant functional tricuspid regurgitation in of 28.6% of the patients. Long term clinical outcomes between the groups were analyzed including risk factors and 5-years mortality. Results: There was no difference in in-hospital mortality between the TT group (1 patient; 2,1%) and the V-A group (4 patients; 3.1%, p=0.25). A stroke occurred in 3 (2.3%) patients from the V-A group and none from the totally endoscopic group (p=0.31). The average aortic cross-clamp time was not significantly different between the groups, with 103 (+/- 39 minutes) and 97 (+/- 46 minutes) in the TT group and the V-A minithoracotomy group(p=0.5). Similarly, in terms of cardiopulmonary bypass time 166+/-53 minutes vs. 166+/-70 minutes (p=0,2). No conversion to full sternotomy or from a totally thoracoscopic approach to the minithoracotomy was required. In follow-up, there was no difference in terms of reoperation rate (98.5% % in VA and 97,8% in TT, p=0,43). There was no difference in overall 5-years survival between the totally thoracoscopic group (94.3%) and the V-A minithoracotomy population (96.2%) (p=0,76). Conclusions: The study proved an equal safety and feasibility of the thoracoscopic periareolar approach and the standard minithoracotomy video-assisted access in mitral valve surgery in 5-years observation.LegendMortality and Reoperation Risk Factors
The comparison of the overall Kaplan-Meier survival rate between the video-assisted group (V-A) and the totally thoracoscopic group (TT) over a 5-year follow-up period.
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