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Background: The lack of depth perception is a significant challenge in two-dimensional (2D) video- assisted/directed minimally invasive cardiac surgery (MICS). Accordingly, restoration of stereoscopic vision is potentially beneficial, and we present a single center experience of a three-dimensional (3D) endoscope system in cardiac surgery without robotic assistance. Methods: We retrospectively reviewed the initial 40 consecutive patients who received totally endoscopic mitral valve (MV) repair using a 3D endoscope system between September 2017 and April 2019. The preoperative characteristics, operative data, and immediate postoperative outcomes, including echocardiographic results, were investigated. Results: In all the patients (n=40, 100%), successful MV repair using the standard repair techniques was achieved regardless of the location of the MV lesion as follows: anterior leaflet (n=8, 20.0%), posterior leaflet (n=15, 37.5%), and both leaflets (n=17, 42.5%). Concomitant tricuspid ring annuloplasty (n=9, 22.5%) and atrial fibrillation ablation (n=7, 17.5%) were performed. There was no mortality. One reoperation for bleeding occurred. One patient had a sternotomy conversion due to aortic dissection immediately after declamping. Postoperative mitral regurgitation (MR) grades were none or trace in 38 patients (95.0%) and mild in 2 patients (5.0%) on predischarge echocardiography. Conclusions: Totally endoscopic MV repair using a 3D endoscope system is technically feasible and safe on the basis of this initial experience.

Background The aim of this study was to evaluate the efficacy of early amiodarone-based pharmacological cardioversion for postoperative atrial fibrillation (POAF) following off-pump coronary bypass grafting (OPCAB). Methods A total of 507 patients who underwent OPCAB between 2015 and 2017 were categorized into POAF (n=94) and no-POAF (n=413) groups. Patients in the POAF group were treated according to the following institutional protocol: 150 mg loading dose of intravenous amiodarone, followed by oral administration with sequential maintenance doses at 600, 400, and 200 mg per day. If sinus rhythm was restored before discharge, patients were discharged without amiodarone or anticoagulants, except for dual antiplatelets. Results Before discharge at index hospitalization, 97.8% of POAF patients had restored sinus rhythm. Independent risk factors for POAF were age, unstable angina, prior percutaneous transluminal coronary angioplasty, and left atrial diameter. The mean follow-up duration was 41.1±12.8 months. Freedom from overall mortality and composite events, including mortality, major bleeding requiring admission and cerebrovascular events, were similar between the 2 groups. Results were consistent after propensity-score matching. Conclusions Amiodarone-based rapid pharmacological cardioversion of POAF resulted in a high sinus rhythm conversion rate (97.9%). Rate of late adverse cardiovascular events including stroke, were low even without anticoagulation. As optimal treatment and anticoagulation guidelines for POAF after OPCAB have not yet been established, amiodarone-based treatment protocols may be considered as a useful option.

Background: Sternal wound complications could increase the hospital cost while decreasing the satisfaction of surgery. Furthermore, it can potentially also lead to life-threatening mediastinitis especially after coronary artery bypass grafting using bilateral internal thoracic artery (BITA). Skill levels of suture technique vary among surgeons and may contribute to an increased wound complication rate. Thus, standardization of surgical wound closure could potentially decrease the surgeon factor. The aim of the study is to compare the wound complication rate between non-invasive surgical skin closure devices (zip surgical skin closure device, Zipline Medical, Campbell, CA, USA) and conventional suture closure. Methods: Three hundred seventy-nine patients who underwent off-pump coronary artery bypass grafting (OPCAB) using BITAs at our institution between 2016 and 2018 were included in this study. Patients were divided into two groups; the Zipline group (zip-group, N=100), and conventional group (con-group, N=279). Following propensity score matching, 95 con-group patients were matched to 169 zip-group patients. Results: The average age and history of cancer were significantly higher in the zip-group (P=0.021 and P=0.023, respectively). However, after propensity score matching, no differences were observed in the demographic data between the groups. In total patients (unmatched), although there was no significant difference in the incidence of deep sternal wound infection (DSWI) between the two groups (zip vs . con, 0% vs . 1.1%, P=0.569), the incidence of post-operative superficial sternal wound infection (SSWI) or dehiscence was significantly higher in the con-group than in the zip-group (1.0% vs . 7.9%, P=0.013). The results were consistent in the matched patients. (DSWI: 0% vs . 0.6%, P>0.999; SSWI or dehiscence: 1.1% vs . 7.1%, P=0.036). Multivariable analysis revealed use of the zip surgical skin closure device showed a preventive effect against wound complications [odds ratio (OR): 0.128, 95% confidence interval (CI): 0.017–0.976, P=0.029]. Conclusions: Zip surgical skin closure devices could decrease superficial wound complication rates compared to conventional suture techniques in OPCAB using BITAs.