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Periareolar endoscopic minimally invasive cardiac surgery: Postoperative scar assessment analysis

Interact Cardiovasc Thorac Surg. 2022 Jul 21:ivac200. doi: 10.1093/icvts/ivac200. Online ahead of print.


OBJECTIVES: The standard approach for minimaly invasive cardiac surgery 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.

METHODS:  All patients underwent periareolar endoscopic minimaly invasive cardiac surgery 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 paper analyzed the aesthetic and functional outcome of the periareolar scar using five 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.

RESULTS: 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], 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 scales, respectively. 97 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.

CONCLUSIONS: Periareolar endoscopic minimaly invasive cardiac surgery is safe and cosmetically appealing. It is feasible and allows for complex mitral valve repair, mitral valve replacement and concomitant surgery. Data from five scar assessment scales suggest that this technique delivers patient-satisfying results regarding functional and cosmetic outcome.

PMID:35863058 | DOI:10.1093/icvts/ivac200

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