A comparative study of three-dimensional high-definition and two-dimensional high-definition video systems in totally endoscopic mitral valve replacement

Background: Three-dimensional vision with improved depth perception and spatial orientation has already proved its superiority to the two-dimensional vision in endoscopic surgery. However, those benefits remain unidentified in cardiac surgery. For the first time, we compare performance of a three-dimensional high-definition video system with a two-dimensional high-definition video system in patients undergoing totally endoscopic mitral valve replacement. Methods: We enrolled 90 patients with mitral valve disease in a single institution, from June 2013 to June 2016. Totally endoscopic mitral valve replacement was performed by the same surgeon using either a three-dimensional high-definition (n=43) or a two-dimensional high-definition (n=47) video system with the same surgical technique. Short-term outcomes were compared between the two groups. All medical records were retrieved from a prospectively maintained database of minimally invasive cardiac surgery. Results: All surgeries were successfully completed under totally endoscopic guidance. There were no intraoperative complications in either group. The use of three-dimensional video system reduced aortic cross-clamp time by approximately 10% (3D vs. 2D: 65.74 +/- 14.32 vs. 72.67 +/- 14.67 min, P=0.027). No significant differences were observed in cardiopulmonary bypass time, postoperative ventilation duration, length of surgical intensive care unit stay, length of hospital stay, and major complications between the two groups. There were no perioperative deaths in either group. Conclusions: Compared with the two-dimensional video system, the three-dimensional high-definition video system provided a better surgical experience with the same operative safety for totally endoscopic mitral valve replacement.