Key result
Totally thoracoscopic periareolar minimally invasive mitral valve surgery was safe and feasible, with a 2.1% in-hospital mortality and 96.9% estimated mid-term survival over a mean 1.7 years.
Why the study?
Because mini-thoracotomy extent and location for MIMVS vary across centers, conclusions on cosmesis are not generalizable, prompting evaluation of the totally thoracoscopic periareolar approach.
Is the totally thoracoscopic periareolar approach for minimally invasive mitral valve surgery safe and feasible in patients with mitral and tricuspid valve disease?
Cohort (n=48)
No
Is the totally thoracoscopic periareolar approach for minimally invasive mitral valve surgery safe and feasible in patients with mitral and tricuspid valve disease?
The totally thoracoscopic periareolar approach for minimally invasive mitral valve surgery appears safe and feasible with excellent mid-term survival and freedom from reoperation.
Supports feasibility in selected patients; leaves open need for RCTs versus sternotomy or other approaches.
INTRODUCTION: Minimally invasive mitral valve surgery (MIMVS) has become a widely accepted alternative to the standard sternotomy approach for treatment of mitral valve (MV) disease. Because the extent and location of mini-thoracotomies employed for MIMVS vary from center to center, the conclusions regarding superior cosmesis are not generalizable. The totally thoracoscopic periareolar (TTP) - MIMVS technique has been used at our department for minimally invasive cardiac surgery since 2015. AIM: To report early surgical data as well as mid-term outcomes in patients undergoing TTP-MIMVS. MATERIAL AND METHODS: Between 2015 and 2017, 48 consecutive patients (mean age: 65.4 ±10; 83% men; EuroSCORE II: 5.1 ±4%) underwent TTP-MIMVS due to mitral and mitral/tricuspid valve (TV) disease; patients' demographics and clinical outcomes were prospectively collected. Kaplan-Meier estimates of survival and freedom from re-intervention were analyzed as well. RESULTS: Mean follow-up was 1.7 (max 2.5) years. Of 48 patients, 33 (69%) underwent isolated MV repair, 4 (8%) isolated MV replacement and 11 (23%) MV/TV repair. The cardiopulmonary bypass and aortic cross-clamp time was 166 ±70 and 103 ±39 min respectively. There was no conversion to either full sternotomy or a mini-thoracotomy approach. Median (interquartile range) duration of intensive care unit stay was 1.2 (1.0-2.0) days. There was one in-hospital death (2.1%) in the TTP-MIMVS group. No strokes or wound infections were observed. Within the investigated follow-up, the freedom from reoperation rate was 96.4%; remote survival was estimated at 96.9%. CONCLUSIONS: The study proved that TTP-minimally invasive surgery was safe and feasible in mitral and tricuspid valve surgery. It has been associated with superior esthetics. Mitral repairs performed through TTP access are durable in mid-term observation.
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Maruszewski et al. (2019) conducted a cohort in Mitral and mitral/tricuspid valve disease (n=48). Totally thoracoscopic periareolar minimally invasive mitral valve surgery (TTP-MIMVS) was evaluated on Mid-term survival. Totally thoracoscopic periareolar minimally invasive mitral valve surgery was safe and feasible, with a 2.1% in-hospital mortality and 96.9% estimated mid-term survival over a mean 1.7 years.
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