Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.
Berlin Institute of Health, Berlin, Germany.
Interact Cardiovasc Thorac Surg. 2022 Jul 9;35(2). doi: 10.1093/icvts/ivac200.
The standard approach for minimally invasive cardiac surgery (MICS) for repair of the atrioventricular valves is a right lateral minithoracotomy. In this study, we report our experience with a periareolar endoscopic approach, which aims at an optimal cosmetic outcome while preserving optimal clinical outcomes.
All patients underwent periareolar endoscopic MICS using high-definition three-dimensional endoscopic visualization without additional rib-spreading. Patients presented with degenerative and/or functional mitral regurgitation. Patients undergoing concomitant tricuspid valve surgery, cryo-ablation, patent foramen ovale closure, left atrial appendage occlusion and/or left atrial myxoma extirpation were included. This descriptive article analysed the aesthetic and functional outcome of the periareolar scar using 5 most common and clinimetrically sound scar assessment scales. For statistical analysis of the scar assessment grading scales, box and whisker plots were calculated depicting median, interquartile range and high and low range data points.
Median scar assessment scale scores for n = 100 male patients (response rate 100/109; 91.7%) were 2 [1, 4], 7.5 [6, 9], 11 [8, 14], 3 [2, 3] and 10 [9, 11] for the Vancouver scar scale, Manchester scar scale, patient scar assessment scale, Stony brook scar evaluation scale and Dermatology Quality of Life Index scale, respectively. Ninety-seven patients received mitral valve repair, 7 mitral valve replacement, whereas 5 had left atrial myxoma extirpation. Concomitant tricuspid annuloplasty, cryo-ablation, left atrial appendage occlusion and patent foramen ovale closure surgery were performed in 12, 29, 5 and 8 patients, respectively. Median procedure, cardiopulmonary bypass and cross-clamp times were 169.5 [154.3, 189.3], 111.5 [97, 127], and 68.5 [58.8, 81] min, respectively.
Periareolar endoscopic MICS is safe and cosmetically appealing. It is feasible and allows for complex mitral valve repair, mitral valve replacement and concomitant surgery. Data from 5 scar assessment scales suggest that this technique delivers patient-satisfying results regarding functional and cosmetic outcomes.
微创心脏手术（MICS）修复房室瓣的标准方法是右外侧小开胸术。本研究报告了我们经乳晕内镜入路的经验，旨在获得最佳美容效果的同时保留最佳临床效果。
所有患者均采用经乳晕内镜 MICS 治疗，使用高清三维内镜可视化技术，无需额外扩肋骨。患者患有退行性和/或功能性二尖瓣反流。包括同时进行三尖瓣手术、冷冻消融、卵圆孔未闭闭合、左心耳闭塞和/或左心房粘液瘤切除术的患者。本描述性文章使用 5 种最常见和临床评估合理的疤痕评估量表分析经乳晕疤痕的美容和功能结果。为了对疤痕评估分级量表进行统计学分析，计算了箱线图和 whisker 图，以描绘中位数、四分位距和高低范围数据点。
100 名男性患者（应答率 100/109；91.7%）的中位数疤痕评估量表评分为 2 [1,4]、7.5 [6,9]、11 [8,14]、3 [2,3]和 10 [9,11]，分别为温哥华疤痕量表、曼彻斯特疤痕量表、患者疤痕评估量表、史东尼布鲁克疤痕评估量表和皮肤病生活质量指数量表。97 例患者接受二尖瓣修复术，7 例患者行二尖瓣置换术，5 例患者行左心房粘液瘤切除术。12 例患者同期行三尖瓣环成形术、冷冻消融术、左心耳闭塞术和卵圆孔未闭闭合术，29 例患者行二尖瓣置换术，5 例患者行左心耳闭塞术，8 例患者行卵圆孔未闭闭合术。中位数手术、体外循环和阻断时间分别为 169.5 [154.3,189.3]、111.5 [97,127]和 68.5 [58.8,81]分钟。
经乳晕内镜 MICS 安全且美容效果良好。它是可行的，并允许进行复杂的二尖瓣修复、二尖瓣置换和同时进行手术。5 种疤痕评估量表的数据表明，该技术在功能和美容效果方面可获得患者满意的结果。
