title: Evolution of mitral valve surgery: toward a totally endoscopic approach.
abstract: 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.
authors.affiliation: Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina 27858, USA.
authors.forename: J E
authors.initials: JE
authors.lastname: Felger
authors.forename: W R
authors.initials: WR
authors.lastname: Chitwood
authors.forename: L W
authors.initials: LW
authors.lastname: Nifong
authors.forename: D
authors.initials: D
authors.lastname: Holbert
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation; D008943:Mitral Valve / Q000601:surgery*; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D012371:Robotics / Q000295:instrumentation*; D013523:Surgical Equipment; D015996:Survival Rate; D020775:Thoracic Surgery, Video-Assisted / Q000295:instrumentation*; D013908:Thoracotomy / Q000295:instrumentation