Three-dimensional Video Assistance Improves Early Results in Minimally Invasive Mitral Valve Surgery.

Abstract

Compared with the mid-sternotomy approach, minimally invasive mitral valve surgery is usually associated with longer surgical times. The increasing use of new technology has facilitated this procedure and shortened its duration, which may further improve surgical results. Since 2004, 152 patients have undergone minimally invasive mitral valve repair. Video-assisted 2D technology was used for the first 112 patients, while video-assisted 3D technology was used for the remaining 40 patients. All patients were divided into three groups: group 1 - the first 50 patients (learning curve using 2D technology); group 2 - 62 patients (past the learning curve using 2D technology); and group 3 - 40 patients (3D technology). Mean patient age was 50 ± 12 years. There was no in-hospital mortality and no conversions to mid-sternotomy. Cardiopulmonary bypass and cross-clamp times were significantly shorter in group 3 compared with groups 2 and 1, respectively (108 ± 19 vs. 124 ± 22 vs. 139 ± 27, p < 0.001; and 76 ± 14 vs. 86 ± 18 vs. 97 ± 18, p < 0.001). Intraoperative echocardiography revealed higher freedom from more than mild residual mitral regurgitation after the first pump-run in group 3 compared to group 2 (97.5% vs. 90.3%, p = 0.04). Patients in the 3D group had less postoperative bleeding (p = 0.026) and a higher glomerular filtration rate before discharge (p < 0.001) compared with the 2D groups. No significant differences were observed in ventilation time (p = 0.066) and intensive care unit duration (p = 0.071). We concluded that in minimally invasive mitral valve repair, 3D video-assisted technology may provide shorter surgical times compared to 2D video-assisted technology.