RF49 MINIMALLY INVASIVE SURGERY: KEY HOLE APPROACH

Abstract

Background and Aim: Minimally invasive surgery through right minithoracotomy is routinely performed in mitral valve repair and the current tendency is to further simplify the procedure and reduce invasiveness and trauma on tissues for faster postoperative recovery. Methods: In our experience, 175 patients underwent minithoracotomy (52,3% males) from August 2012 to May 2018. In the last 6 months, 7 patients were selected for “Key Hole Surgery” through a 3-3,5 cm periareolar incision along the convexity of the right areola; the thoracoscopy was positioned on anterior axillar line in the same right intercostal space. Results: The endoscopic vision was always obtimal, ensuring an effective control in repairing procedures. A complete ring was always implanted; according to the features and mechanism of mitral regurgitation, in some cases we performed a resection of the posterior leaflet, in other cases we preferred a “respect-no-resect” approach (even chordal traslocation). Conclusions: Compared to anterolateral minithoracotomy, the advantages of this approach are a minor trauma (often caused by intercostal retraction), better control of postoperative pain and better result from the aesthetic point of view, because the incision exploits the hyperchromy of the periareolar area making the scar almost invisible. The indirect disadvantages of the procedure are related to the fact that such a limited incision does not permit central cannulation and aortic cross-clamping, from which the need of a femoral peripheral cannula and the use of the device Intraclude for aortic clamping are derived; this guarantees a “no-touch-aorta” intervention and great reduction of risk of post-operative bleeding.