Comparison of Totally Thoracoscopic and Traditional Sternotomy Approaches for Mitral Valve Replacement

BACKGROUND: We aimed to investigate the feasibility and safety of mitral valve replacement using a totally thoracoscopic approach in comparison with traditional median sternotomy. METHODS: Between January 2016 and December 2017, 94 consecutive patients who underwent mitral valve replacement were divided into two groups: A thoracoscopic group (43 cases) and a traditional group (51 cases). For the thoracoscopic group, all patients underwent total thoracoscopic procedures with femoral arterial and venous cannulation to cardiopulmonary bypass, transthoracic aortic cross-clamp, and antegrade cardioplegia. Three intercostal ports in the right chest were used for access in the thoracoscopic group. The operation was performed completely under two-dimensional video. For the traditional group, all operations were done with traditional median sternotomy. RESULTS: All the operations were successfully performed. The thoracoscopic group had longer aortic cross-clamping and cardiopulmonary bypass times compared with the traditional group (62.30 ± 8.17 minutes versus 44.90 ± 12.00 minutes, P < .001; 92.33 ± 12.03 minutes versus 74.22 ± 14.72 minutes, P < .001). The two groups did not show statistically significant differences with respect to operative times (184.26 ± 32.49 minutes versus 181.47 ± 23.31 minutes, P = .631). In addition, the postoperative mechanical ventilation, ICU stay, and postoperative hospital stay times and postoperative drainage were 10.14 ± 2.21 hours and 11.35 ± 2.58 hours (P = .016), 21.40 ± 3.15 hours and 29.12 ± 6.59 hours (P < .001), 8.70 ± 2.52 days and 10.04 ± 3.11 days (P = .023), and 325.71 ± 97.11 mL and 396.57 ± 121.50 mL (P < .001), respectively. Major postoperative complications occurred in three (6.98%, P = .873) cases of the thoracoscopic group. Four (7.84%) cases of the traditional group had postoperative complications. CONCLUSIONS: Despite the disadvantages such as long cross-clamp and cardiopulmonary bypass times, totally thoracoscopic mitral valve replacement is feasible and safe. More importantly, one of the principal advantages with three intercostal ports over standard sternotomy is avoiding retrosternal adhesion, thus lowering the risk of needing to redo a cardiac procedure in the future.