Key result
Technical refinements in minimally invasive mitral surgery are linked to ~18-minute shorter cardiopulmonary bypass times.
Why the study?
Minimally invasive mitral valve surgery has evolved over the last 2 decades, but the impact of era and technical improvements on perioperative outcomes needed evaluation.
Do technical advancements (3D visualization, PTFE loops, preoperative CT) improve perioperative outcomes and operative times in patients undergoing minimally invasive mitral valve surgery?
Observational (n=1,000)
No
Do technical advancements (3D visualization, PTFE loops, preoperative CT) improve perioperative outcomes and operative times in patients undergoing minimally invasive mitral valve surgery?
Technical advancements in minimally invasive mitral valve surgery, including 3D visualization, PTFE loops, and preoperative CT, significantly reduce operative times and improve periprocedural safety.
Answers are grounded in this paper and cite their sources.
May shorten operative times in minimally invasive mitral valve surgery; hypothesis-generating pending randomized confirmation.
OBJECTIVES: Minimally invasive mitral valve surgery (MIMVS) has evolved over the last 2 decades. The aim of the study was to identify the impact of era and technical improvements on perioperative outcome after MIMVS. METHODS: A tota of 1000 patients (mean age: 60.8 ± 12.7 years, 60.3% male) underwent video-assisted or totally endoscopic MIMVS between 2001 and 2020 in a single institution. Three technical modalities were introduced during the observed period: (i) 3D visualization, (ii) use of premeasured artificial chordae (PTFE loops) and (iii) preoperative CT scans. Comparisons were made before and after the introduction of technical improvements. RESULTS: A total of 741 patients underwent isolated mitral valve (MV) procedure, whereas 259 received concomitant procedures. These consisted of tricuspid valve repair (208), left atrium ablation (145) and persistent foramen ovale or atrial septum defect (ASD) closure (172). The aetiology was degenerative in 738 (73.8%) patients and functional in 101 patients (10.1%). A total of 900 patients received MV repair (90%), and 100 patients (10%) underwent MV replacement. Perioperative survival was 99.1%, and periprocedural success 93.5% with a periprocedural safety of 96.3%. Improvement in periprocedural safety attributed to the lower rates of postoperative low output (P = 0.025) and less reoperations for bleeding (P < 0.001). 3D visualization improved cross-clamp (P = 0.001) but not cardiopulmonary bypass times. The use of loops and preoperative CT scan both had no impact on periprocedural success or safety but improved cardiopulmonary bypass and cross-clamp times (both P < 0.001). CONCLUSIONS: Increased surgical experience improves safety in MIMVS. Technical improvements are related to increased operative success and decreased operative times in patients undergoing MIMVS.
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Gollmann‐Tepeköylü et al. (2023) conducted an observational in Mitral valve disease (n=1,000). Technical improvements (preoperative CT scans, PTFE loops, 3D endoscopy) vs. Standard techniques (eras prior to the introduction of each improvement) was evaluated on Cardiopulmonary bypass time (minutes) - Preoperative CT scan comparison (p=<0.001). The introduction of technical improvements in minimally invasive mitral valve surgery, including preoperative CT scans and PTFE loops, significantly reduced cardiopulmonary bypass and cross-clamp times while maintaining high periprocedural safety.
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