Pilot study of totally thoracoscopic periareolar approach for minimally invasive mitral valve surgery. Towards even less invasive?

Abstract

Introduction Minimally invasive mitral valve surgery (MIMVS) has become a widely accepted alternative to the standard sternotomy approach for treatment of mitral valve (MV) disease. Because the extent and location of mini-thoracotomies employed for MIMVS vary from center to center, the conclusions regarding superior cosmesis are not generalizable. The totally thoracoscopic periareolar (TTP) – MIMVS technique has been used at our department for minimally invasive cardiac surgery since 2015. Aim To report early surgical data as well as mid-term outcomes in patients undergoing TTP-MIMVS. Material and methods Between 2015 and 2017, 48 consecutive patients (mean age: 65.4 ±10; 83% men; EuroSCORE II: 5.1 ±4%) underwent TTP-MIMVS due to mitral and mitral/tricuspid valve (TV) disease; patients’ demographics and clinical outcomes were prospectively collected. Kaplan-Meier estimates of survival and freedom from re-intervention were analyzed as well. Results Mean follow-up was 1.7 (max 2.5) years. Of 48 patients, 33 (69%) underwent isolated MV repair, 4 (8%) isolated MV replacement and 11 (23%) MV/TV repair. The cardiopulmonary bypass and aortic cross-clamp time was 166 ±70 and 103 ±39 min respectively. There was no conversion to either full sternotomy or a mini-thoracotomy approach. Median (interquartile range) duration of intensive care unit stay was 1.2 (1.0–2.0) days. There was one in-hospital death (2.1%) in the TTP-MIMVS group. No strokes or wound infections were observed. Within the investigated follow-up, the freedom from reoperation rate was 96.4%; remote survival was estimated at 96.9%. Conclusions The study proved that TTP-minimally invasive surgery was safe and feasible in mitral and tricuspid valve surgery. It has been associated with superior esthetics. Mitral repairs performed through TTP access are durable in mid-term observation.

Periareolar approach in female patients undergoing mitral and tricuspid valve surgery: An almost invisible surgical access

“…The rate of postoperative pacemaker implantation was comparable to the results reported by Poffo 9 . ECC and cross‐clamping time were comparable to the results reported by Maruszewski et al, 10 who did not find any statistically significant difference between classical and periareolar approaches.…”

Minimally Invasive and Robotic Mitral Valve Surgery: Methods and Outcomes in a 20-Year Review

“…The majority of groups studied in our review applied this method. 7 -30 CPB time and myocardial ischemic time were 131.1 ± 24.5 min and 89.1 ± 16.8 min, respectively and 1.8% conversions to sternotomy occurred. Of note more annuloplasty rings than bands were used.…”

“…3D imaging appeared only recently but can certainly enhance the spatial orientation inside the chest and the left atrium. 34 Periareolar 30 and retroaxillary 14 approaches are the cosmetically most attractive and are becoming more and more common. Videoscopic equipment is available at most central operating rooms and except for the endoballoon technique induction of cardioplegia is relatively straight forward.…”

A randomized controlled trial (PAMI trial) on our new trend periareolar minimally invasive (PAMI) technique versus inframammary approach for minimally invasive cardiac surgery

“…This was followed by Durdu et al [7] highlighting the importance of the periareolar approach in women. Maruszewski et al in Poland published a pilot study about the totally thoracoscopic periareolar approach in 2019, discussing the safety and feasibility of this approach [8].…”