ISMICS Home  |  2022 Scientific Annual Meeting  |  Past & Future Meetings
International Society For Minimally Invasive Cardiothoracic Surgery

Back to 2021 ePosters


The Impact of Era and Technical Improvements on a High Volume Minimally Invasive Mitral Valve Surgery Program
Nikolaos Bonaros, Daniel Hoefer, Johannes Holfeld, Can Gollmann-Tepeköylü, Cenk Oezpeker, Elfriede Ruttmann, Lukas Stastny, Michael Grimm, Ludwig Mueller
Innsbruck Medical University, Innsbruck, Austria

BACKGROUND: The aim of the study was to identify the impact of era and technical improvements on perioperative outcome after minimally invasive mitral valve surgery (MIMVS).
METHODS: We retrospectively investigated 1000 patients (mean age: 60.8±12.7y, 60.3% male) who underwent minimally invasive or endoscopic mitral valve surgery between 2001-2020 in a single institution. The patients were allocated to 4 groups according to the case number quartiles. Periprocedural success, safety and operative times were identified as outcome parameters. Operative success was defined as: Successful primary mitral repair without conversion to replacement, or larger thoracic incisions, no residual MR>mild at intraoperative TEE, and no need for reoperation within 30d. The definition of safety included: freedom from perioperative (30d) death, myocardial infarction, stroke, use of ECMO or reoperation for bleeding. Three technical interventions were introduced during the observed period of 19 years: (1) the introduction of a fully endoscopic technique through 3D visualization, (2) the adoption of pre-measured loops of neochordae for prolapse correction and (3) the implementation of a preoperative CT scan to exclude unsuitable candidates for MIMVS. Comparisons were made between the 4 quartiles and before and after the introduction of technical improvements by chi-square test and one-way ANOVA. RESULTS:
Perioperative survival, periprocedural success and safety were 99.1%, 93.5% and 96.3% respectively. There was a significant improvement in the combined periprocedural safety endpoint within the different eras mainly attributed to the lower need for ECMO support (p=0.036) and less reoperations for bleeding (p=0.007). On the other hand, the influence of era according to the different quartiles on periprocedural success was not statistically significant (p=0.590). The impact of technical improvements was thoroughly investigated in 897/1000 patients who underwent mitral valve repair on an intent to treat basis. The implementation of endoscopic techniques through 3D visualization had a significant impact on periprocedural success but not on safety. All three improvements led to decreased cardiopulmonary bypass and cross-clamp times in this patients’ cohort (s. Table 1). CONCLUSIONS:
Increased surgical experience improves safety in MIMVS. Technical improvements are related to increased operative success and decreased operative times in patients undergoing mitral repair.


Back to 2021 ePosters

By using this site, you agree to our updated Privacy Policy.  Got it