Early and Late Outcomes in Minimally Invasive Mitral Surgery – 200 Cases

Abstract

Background: This study assessed the clinical and echocardiographic outcomes for patients who underwent minimally invasive mitral valve surgery (MIMVS) at St Vincent's Public and Private Hospitals, Sydney. Methods: The database at St Vincent's Hospital was reviewed. From August 2007 to Dec 2015, 200 patients underwent MIMVS via a right mini-thoracotomy and femoral cannulation under a single surgeon. The perioperative data and follow-up data were retrospectively collected and analysed. Robotic surgeries were excluded. Results: The mean age was 56 ± 15 years, 82 were female. 153 patients received mitral valve repair and 47 underwent replacement. The predominant pathology was myxomatous degenerative for the repair and rheumatic for the replacement. No patient was converted to sternotomy and only one had failed repair (repair rate was 99.4%). The mean aortic cross-clamp time and CPB time was 74 ± 20 min and 101 ± 28 min. There was no hospital mortality. Postoperative complications included atrial fibrillation in 59, stroke in 3, TIA in 2, renal failure in 3, re-exploration for bleeding in 6. Median intubation time, ICU stay, hospital stay, drain bleeding was 7 hours, 2 days, 6 days, and 500 ml, respectively. There were 2 late deaths and 3 reoperations (1 after repair and 2 after replacement) at 26 months of mean follow-up. Overall survival was 99 ± 1% and 92 ± 1% at 1 and 5 years. Freedom from mitral regurgitation (≥ moderate) was 100% and 95 ± 1% at 1 and 5 years, and freedom from reoperation was 100% and 93 ± 1% at 1 and 5 years. Conclusions: MIMVS through right thoracotomy can be safely and effectively performed, with low perioperative morbidity and mortality, high repair rate, and low rates of reoperation and death.