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Ann Thorac Surg 2001;72:1203-1209
© 2001 The Society of Thoracic Surgeons
a Division of Cardiothoracic Surgery, Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
Address reprint requests to Dr Chitwood, Department of Surgery, Division of Cardiothoracic Surgery, Brody School of Medicine, East Carolina University, 600 Moye Blvd, Greenville, NC 27858
e-mail: chitwoodw{at}mail.ecu.edu
Presented at the Thirty-seventh Annual Meeting of The Society of Thoracic Surgeons, New Orleans, LA, Jan 29–31, 2001.
Background. Our study evaluates a series of video-assisted minimally invasive mitral operations, showing safe progression toward totally endoscopic techniques.
Methods. Consecutive patients with isolated mitral valve disease underwent either manually directed (n = 55) or voice-activated robotically directed (n = 72) video-assisted mitral operations. Cold blood cardioplegia, a transthoracic aortic clamp, a 5-mm endoscope, and a 5-cm minithoracotomy were used. This video-assisted minimally invasive mitral operation cohort was compared with a previous sternotomy-based mitral operation cohort (n = 100).
Results. Group demographics, New York Heart Association classification, and cardiac function were similar. Repairs were performed in 61.8% manually directed (n = 34), 75.0% robotically directed (n = 54), and 54% sternotomy-based (N = 54) mitral operations. The robotically directed technique showed a significant decrease in blood loss, ventilator time, and hospitalization compared with the sternotomy-based technique. Manually directed mitral operations compared with robotically directed mitral operations had decreased arrest times (128.0 ± 4.5 minutes compared with 90.0 ± 4.6 minutes; p < 0.001) and decreased perfusion times (173.0 ± 5.7 minutes compared with 144.0 ± 4.6 minutes; p < 0.001). In the minimally invasive mitral operation cohort, complications included reexploration for bleeding (2.4%; n = 3) and one stroke (0.8%), whereas the 30-day mortality was 2.3% (n = 3).
Conclusions. Video-assisted mitral surgery provides safe and effective results when compared with conventional sternal approaches. These positive results show a safe and stepwise evolution toward a totally endoscopic mitral valve operation.
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