INITIAL EXPERIENCE IN TOTAL ENDOSCOPIC MITRAL VALVE SURGERY WITH THREE–DIMENSIONAL VIDEO–ASSISTED TECHNOLOGY

Abstract

Abstract Background Minimally invasive approach is nowadays the gold standard for mitral valve disease treatment. New technological tools are the key to improve surgical results and to reduce the biological invasiveness. We report our initial experience in total endoscopic mitral valve surgery using three–dimensional video–assisted technology (EinsteinVision® 3.0, B. Braun, Aesculap AG, Tuttlingen, Germany). Methods From July 2023 to December 2023, 29 patients underwent total endoscopic mitral valve surgery with three–dimensional video–assisted technology and discharged. Results Median (Q1–Q3) age of our population was 60 years (47–67) and 65.5% were males. Median (Q1–Q3) logistic Euroscore was 2.09 (1.5–4.4) and median (Q1–Q3) EuroSCORE II was 0.84 (0.6–1.2). The majority of patients were in NYHA class II and the 48.3% presented with pulmonary hypertension (PAPs > 30 mmHg). Median PAPs resulted 34.5 mmHg. One patient (3.4%) suffered from mitral valve endocarditis. No conversion to full sternotomy was necessary. In six patients with left coronary dominance (20.6%) we used indocyanine green fluorescence to conduct a real–time analysis of the course of the circumflex artery during surgery. No perioperative acute myocardial infarction was observed. No 30–day mortality was reported. One patient (3.4%) suffered from renal failure requiring dialysis, respiratory failure with tracheostomy and pneumonia. Post–operative atrial fibrillation was observed in 7 patients (24.1%) and 1 patient (3.4%) required Pace–maker implantation due to third degree AV block. No re–thoracotomy for bleeding was observed and 24.1% of patients required transfusions with packed blood cells. Non stroke were detected. Median (Q1–Q3) ventilation time was 5 hours (4–7). Median (Q1–Q3) intensive care unit postoperative length of stay were 2 (2–2) days and 7 (7–8) days respectively. Conclusions In our experience, total endoscopic mitral valve surgery with three–dimensional video–assisted technology is safe and feasible with good postoperative outcomes. Moreover, the possibility to use indocyanine green fluorescence to detect the course of the circumflex artery significantly assist surgeons in localizing and avoiding it, thus reducing the risk of perioperative myocardial infarction.