FIRST YEAR EXPERIENCE IN TOTAL ENDOSCOPIC MITRAL VALVE REPAIR WITH THREE-DIMENSIONAL VIDEO-ASSISTED TECHNOLOGY

Background: The minimally invasive approach is the gold standard for mitral valve surgery. Advancements in technology are crucial for enhancing surgical outcomes and reducing invasiveness. We present our experience with total endoscopic mitral valve repair. Methods: From July 2023 to June 2024, 61 patients underwent total endoscopic mitral valve repair with three-dimensional video-assisted technology (EinsteinVision® 3.0, B. Braun, Aesculap AG, Tuttlingen, Germany). Median age was 61 years (53-68) and 62.3% were males. Median EuroSCORE II was 0.76 (0.56-1.14). Results: The majority of patients were in NYHA class II and 42.6% had pulmonary hypertension. Seven (11.5%) patients underwent associate procedures. No conversion to full sternotomy was necessary. In six (9.84%) patients with left coronary dominance we used indocyanine green fluorescence for a real-time analysis of the course of the circumflex artery during surgery. No perioperative acute myocardial infarction or stroke was observed. No 30- day mortality was reported, while one patient (1.6%) suffered from sepsis and multi-organ failure leading to in-hospital death. Atrial fibrillation was observed in 14 patients (23%) and 1 patient (1.6%) required Pace-maker implantation. We observed 2 (3.3%) re-thoracotomies for bleeding and 41% of patients required blood transfusions. Median ventilation time was 5 hours (4-6). Median intensive care unit and in-hospital stay were 2 (2-2) and 7 (7-9) days. Conclusions: Total endoscopic mitral valve surgery is safe and feasible with good postoperative outcomes. Moreover, the possibility to use indocyanine green fluorescence to detect the course of the circumflex artery assist surgeons, reducing the risk of perioperative myocardial infarction.