The Heart Valve Society

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3D compared to 2D Video Assistance Improves Early Outcomes in Minimally Invasive Mitral Valve Repair Surgery
Eilon Ram, Ami Shinfeld, Eyal Nahum, Ronny Ben-Avi, Alexander Kogan, Sergey Preisman, Shany Levin, Sagit Ben Zekry, Ehud Raanani.
Sheba Medical Center, Israel, Ramat Gan, Israel.

OBJECTIVE: Minimal invasive mitral valve surgery may reduce the need for blood products, lessen post-operative atrial fibrillation, decrease pain and provide better cosmetic results, compared to mid-sternotomy. However, these approaches are usually associated with longer cardiopulmonary bypass and cross-clamp times. The increasing use of new technology has facilitated the procedure and shortened its duration time. Mitral valve repair (MVr) is a reconstructive procedure and requires 3D vision. We compared the outcomes of patients who underwent minimally invasive MVr using either three-dimensional (3D) or two-dimensional (2D) video-assisted technology.
METHODS: Of the 142 patients since 2004 who underwent minimally invasive MVr, the first 111 underwent the procedure through heart port (HP) video-assisted 2D technology, and the remaining 31 patients received HP video-assisted 3D technology. For the purpose of this study, we divided the patients into three groups: Group 1 - the first 50 patients (learning curve), Group 2 - the next 61 patients (2D technology), and Group 3 - 31 patients (3D technology).
RESULTS: Mean patient age was 5014 years, and 103 (73%) patients were male. Cardiopulmonary bypass and cross-clamp times were significantly shorter in Group 3 compared with Groups 2 and 1, respectively (11020 vs. 12423 vs. 13927, p<0.001; and 7925 vs. 8618 vs. 9718, p=0.001). There were no cases of in-hospital mortality, and none of the patients were converted to mid-sternotomy. Major post-operative complications included: revision due to bleeding or tamponade in 3 patients (2.1%), CVA in one patient (0.7%), and reversible renal failure in 3 patients (2.1%), with no significant differences between the groups. Early echo revealed that there is a trend of less residual MR after first pump-run in Group 3. 96.7% of patients in Group 3, 90.2% in Group 2 and 89.8% in Group 1 had up to mild mitral regurgitation (MR) (p=0.171).
CONCLUSIONS: By enhancing the dimension of surgical vision, minimally invasive MVr using 3D video-assisted technology provides significantly shorter cardiopulmonary bypass and cross-clamp times. Furthermore, the success rate is high with low rates of residual MR. Improved technology will further facilitate the procedure and reduce its duration time.


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