Comparison Of 2d And 3d Totally Thoracoscopic Periareolar Mitral Valve Surgery
Radoslaw Smoczynski, Jakub Staromlynski, Michal Pasierski, Anna Witkowska, Mariusz Kowalewski, Maciej Bartczak, Dominik Drobinski, Wojciech Sarnowski, Piotr Suwalski.
Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland.
Background: Right lateral minithoracotomy remains most frequently used access for MIMVS and is recommended to reduce injury, blood loss and need for transfusion, as well as to shorten the length of hospital stay and rehabilitation time. The use of stereoscopic vision systems is a clear advantage of robotic surgery; however, the latest 3D thoracoscopic systems in our clinical observation already strongly facilitate the totally thoracoscopic surgery. Current investigation aimed to evaluate surgical outcomes and long-term survival in patients undergoing MIMVS with 3D vs 2D devices. Methods: We retrospectively analyzed 400 patients who underwent minimally invasive mitral valve or mitral and tricuspid valve surgery between 2011 and 2018. Surgical incision involved ˝ of the circumference of a nipple. Two thoracoscopic system were used: 3D vision system EinsteinVision and 2D EndoCAMeleon. Cardiopulmonary bypass, aortic cross clamp and operating times were analyzed. Long-term survival analysis was performed with Cox proportional hazards models used for computations.Results: Of included patients, 197 were operated using a 2D imaging system and 203 with a 3D imaging system. Between the groups there were no difference in age (median 65.9 in 2D group vs 65.6 in 3D group, P=0.34), baseline surgical risk (EuroSCORE 1.83 vs 1.93, P=0.35) or tricuspid valve intervention (31.6% vs 31.03%, P=0.91). There were no statistically significant differences in cardiopulmonary bypass time (161,4vs.160,1min, p=0.95), aortic cross-clamp time (71,7vs80,2min, p=0.83). However significant shorter cross-clamp time were observed among group with Gore-Tex loop’s implantation and 3D vision assist in comparison to 2D imaging system (98,6±32,7 vs. 114,5±29,2min; p=0.04). Over 8-year study period, there was no difference in survival between two groups (Hazard Ratio, for 3D imaging, 1.07; [95%Confidence Interval: 0.59-1.93].Conclusion: 3D imaging system reduce cross-clamp time and cardiopulmonary bypass time in complex mitral valve repair with Gore-Tex loop’s implantation. The study proved an equal safety and feasibility of the totally thoracoscopic periareolar 2D and 3D access in minimally invasive mitral valve surgery.
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