C17 SIMPLIFIED MINIMALLY INVASIVE MITRAL VALVE SURGERY THROUGH A DIRECT VISION TRANSAXILLARY APPROACH: PROCEDURAL AND 30–DAYS OUTCOMES

Abstract

Abstract Background Minimally invasive cardiac surgery through right mini–thoracotomy access is nowadays an established approach for the treatment of mitral valve pathologies. Several thoracic incisions have been described and different techniques used for cardiopulmonary bypass, myocardial protection and valve exposure. Aim of this study is to review our early results with a minimally invasive approach characterized by a lateral right trans–axillary (TAx) approach and direct vision. Methods Prospectively collected data of patients who underwent mitral valve surgery between 2018 and 2021 were reviewed. Among them, 245 patients underwent minimally invasive mitral valve surgery through TAx access. A single incision at the fourth right intercostal space on the anterior axillary line, 3–to–5 cm in length (Fig 1), allowed a 90° direct view exposure of the mitral valve (Fig 2) and the subvalvular apparatus (Fig 3). A transthoracic clamp was invariably used to achieve the cardioplegic arrest. Results Mean age of the patients was 63 years and the mean EuroSCORE II was 1.6. Regurgitation was the prevalent mitral valve dysfunction (91%). Mitral valve repair was performed in 87% of the cases using several techniques including a combination of annuloplasty, leaflet resection and sliding, placement of neochordae and repair of the commissures. In patients with degenerative disease, the rate of valve repair was 92%. Tricuspid annuloplasty was associated in 10% of the cases. There was no in–hospital death; the rates of postoperative stroke and TIA were 0.4% and 1.2%, respectively. Median mechanical ventilation time was 3 [0–6] hours with 40% of the patients extubated in theatre at the end of the procedure. Median ICU stay was 24 [21–46] hours. Three patients had superficial complications of the thoracic wound and in 7 cases of the groin incision. After a median time of 7 [6–8] days, all the patients were successfully discharged from the hospital. The pre–discharge echocardiogram revealed none or trace residual mitral regurgitation in up to 96% of the patients who underwent mitral valve repair with a mean gradient across the valve of 3 [2–4] mmHg. Conclusions The TAx approach for minimally invasive mitral valve surgery is safe and allows a quick functional recovery. A superb direct view of the mitral apparatus and the ascending aorta, facilitates the exposure and the surgical repair of the valve with no need of any endoscopic nor an endoaortic balloon occlusion system support.