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. © 2001 by The Society of Thoracic Surgeons.
Felger, J. E., Chitwood, W. R., Nifong, L. W., & Holbert, D. (2001). Evolution of mitral valve surgery: Toward a totally endoscopic approach. Annals of Thoracic Surgery, 72(4), 1203–1209. https://doi.org/10.1016/S0003-4975(01)02978-2