International Society For Minimally Invasive Cardiothoracic Surgery

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Three-dimensional Video Assistance Improves Early Results In Minimally Invasive Mitral Valve Surgery
Eilon Ram1, Yaron Moshkovitz2, Ami Shinfeld1, Eyal Nahum1, Alexander Kogan1, Elchanan Zuroff1, Ehud Raanani1.
1Sheba Medical Center, Ramat Gan, Israel, 2Assuta Medical Center, Tel-Aviv, Israel.

Background.Compared with mid-sternotomy approach,minimal invasive mitral valve surgery is usually associated with longer cardiopulmonary bypass and cross-clamp times. The increasing use of new technology has facilitated this procedure and shortened its time duration, which may further improve surgical results.Methods. Since 2004, 152 patients underwent minimally invasive mitral valve repair. The first 112 underwent the procedure using video-assisted 2D technology, and the remaining 40 patients using video-assisted 3D technology. Patients were divided into three groups: Group 1 - the first 50 patients (learning curve using 2D technology); Group 2 - 62 patients (past the learning curve using 2D technology); and Group 3 - 40 patients (3D technology).Results.Mean patient age was 5012 years, and 110 (72%) patients were male. There were no cases of in-hospital mortality, and no conversions to mid-sternotomy. Cardiopulmonary bypass and cross-clamp times were significantly shorter in Group 3 compared with Groups 2 and 1, respectively (10819 vs. 12422 vs. 13927, p<0.001; and 7614 vs. 8618 vs. 9718, p<0.001). Intraoperative echocardiography revealed higher freedom from more than mild residual mitral regurgitation after first pump-run in Group 3 compared to Group 2 (97.5% vs. 90.3% respectively, p=0.04).Conclusions. 3D video-assisted technology may provide shorter cardiopulmonary bypass and cross-clamp times compared to 2D video -assisted technology incorporated in minimally invasive mitral valve repair. Furthermore, it may provide higher success rates of valve repair with lower rates of residual mitral regurgitation.

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