International Society For Minimally Invasive Cardiothoracic Surgery

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Comparison Of Direct Vision Mini Thoracotomy And 3D Fully Endoscopic Mitral Valve Surgery
Daniel Hoefer, Herbert Hangler, Christoph Krapf, Nikos Bonaros, Johannes Holfeld, Cenk Özpeker, Michael Grimm, Ludwig Mueller.
Cardiac Surgery Innsbruck, Innsbruck, Austria.

Background:Various “minimally invasive” methods for mitral valve (MV) procedures are established, however, no consent exists concerning superiority of one distinct procedure. We evaluate the outcome of two different minimally invasive mitral valve procedures.
Methods:Between 2001 and 2018 a total number of 900 minimal invasive valve procedures were performed at our center. In group 1 (n=600) a video assisted direct vision mini thoracotomy was performed, group 2 (n=300) was treated with 3D fully endoscopic MV surgery. Various reconstructive methods (artificial chords, resection, sliding leaflet plasty, patch augmentation, ring implantation) or valve replacement were applied in both groups.
Results:Demographic data and etiology of MV disease (79% degenerative) were not significantly different between the two groups. Operative times were almost equal (group 1 vs. group 2: mean extracorporeal circulation time 204 minutes vs. 210 minutes, mean aortic cross clamp time 112 minutes vs. 113 minutes). Conversion to sternotomy occurred more often in group 1 (7.4% vs. 3%; p=0.04), as well as conversion to MV replacement (4.7% vs. 1.3%; p=0.05). Blood transfusions were necessary in 9.6% in group 1, in 6.5% in group 2 (p=0.07), revisions for bleeding occurred significantly more often in group 1 (12.9% vs. 4.4%; p=0.003). In both groups the procedure was safe with perioperative death rates of 5% vs 0.7%; p=0.04. Repair results were even better in group 2 with no sign of MI at discharge in 75% vs 65% in group 1; p=0.02). Reoperation for recurrent MI also was a rare event in both groups (5% in group 1 vs. 0.5% in group 2; p=0.01).
Conclusions:Patients, types of lesions and operative techniques were comparable within the two groups. Operative times show no significant difference despite technically more demanding procedure in endoscopically treated patients. Repair rates and incidence of severe complications as well as mortality were even better in the fully endoscopic group. Both methods are feasible and safe, however, the totally endoscopic procedure is even less invasive with equal or better results and therefore superior.

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