Abstract
BackgroundThe totally thoracoscopic procedure for mitral valve (MV) disease is a minimally invasive method. We investigated the procedure’s feasibility, safety and effectiveness when it was performed by an experienced operator.MethodsWe retrospectively analysed 53 consecutive patients with MV disease treated between December 2014 and April 2017 by minimally invasive procedures. The procedures were performed on femoral artery-vein bypass through three 2–4 cm incisions, with one additional penetrating point on the right chest wall under totally thoracoscopic visual guidance and surveillance of transoesophageal echocardiography.ResultsTwo patients who underwent intraoperative conversion to sternotomy were excluded due to indivisible pleural cavity adhesion. Of the others (38 female patients, average age, 49 ± 14 years, left ventricular ejection fraction, 59 ± 7%), 34 received MV replacement for rheumatic mitral lesions, which was redone for one patient after the discovery of serious paravalvular leakage, 17 received MV repair for mitral regurgitation (with 4 secondary to atrial septum defect, 2 diagnosed with left atrial myxoma, and 2 redone for mitral valve replacement due to repair failure), 28 received additional tricuspid valvuloplasty, and one patient received a Warden procedure. The cardiopulmonary bypass and aortic cross clamp times were 144 ± 39 min and 80 ± 22 min, respectively. Postoperational chest tube drainage in the first 48 h was 346 ± 316 ml. The ventilation time and intensive care unit stay length were 11 ± 11 h and 23 ± 2 h, respectively. One patient died of disseminated intravascular coagulation and prosthesis thrombosis with fear of anticoagulation-related bleeding.ConclusionsThe totally thoracoscopic procedure on mitral valves by an experienced surgeon is technically feasible, safe, effective and worthy of widespread adoption in clinical practice.
Highlights
Accumulating knowledge of the structure, function, and pathology of the mitral valve (MV) has led to favourable surgical results in MV procedures
Written informed consent was preoperatively obtained from each participant and/or their parents or guardians, and the patients were fully informed about the technique and were able to choose a standard median sternotomy according to their preference
We initiated the protocol at the end of 2014, and since that time, totally endoscopic procedure on MV has become the preferred approach for selected patients with MV disease, no matter whether the disease was isolated or combined with tricuspid valve (TV) disease and atrial septal defect (ASD)
Summary
Accumulating knowledge of the structure, function, and pathology of the mitral valve (MV) has led to favourable surgical results in MV procedures. Advances in imaging and surgical instruments have allowed surgeons to perform less invasive sternum-sparing MV surgery [1]. Endeavours to reduce surgical trauma, hasten patient recovery, improve cosmetics, and increase patient satisfaction continued to further promote minimally invasive procedures. Additional minimally invasive surgical approaches, such as total video-assisted thoracoscopy or robotic assistance, have been applied to repair. Jiang et al Journal of Cardiothoracic Surgery (2018) 13:133 congenital heart defects to minimize surgical trauma and improve cosmetic results [7,8,9]. Apart from comparable merits in cosmetics to robotic surgery, an approach using totally thoracoscopy assistance to repair MV without complicated hardware equipment has a remarkable advantage [10]. The totally thoracoscopic procedure for mitral valve (MV) disease is a minimally invasive method. We investigated the procedure’s feasibility, safety and effectiveness when it was performed by an experienced operator
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