Abstract
Objectives: To compare the long term outcomes between minimally invasive mitral valve repair (MiMVR) and conventional surgery. Current retrospective comparisons between the techniques frequently report echocardiographical (echo) outcomes early after surgery and rarely report them later. Methods: Patients were selected for MiMVR by the surgical multi-disciplinary meeting from June 2008-March 2013. Patients included had at least two transthoracic post-operative echocardiograms. Echocardiographic parameters including left ventricular size and systolic function, degree of mitral regurgitation (MR) and mean mitral valve gradient were recorded. Clinical outcomes including all-cause mortality, re-operation, recurrence of at least moderate MR and elevated mean mitral valve gradients > 5 mmHg were recorded and compared using Kaplan-Meier survival analysis. Results: 223 patients were screened, 96 (43%) met the criteria and were included. Thirty-seven patients underwent conventional surgery and 59 underwent MiMVR. Mean clinical follow-up was 6.3 years and echo follow up was 3.2 years. There was a significantly higher recurrence of moderate MR in the conventional group (38% (n = 19) versus 17% (n = 10)). The mean LV end-diastolic diameter was 4.8 cm (conventional) versus 5.0 cm (MiMVR). The incidence of elevated PG was 26% (n = 13, conventional) and 23% (n = 14, MiMVR). There was no significant difference in incidence in re-operation (conventional 12% (n = 6), MiMVR 8.3% (n = 5)). Long-term mortality was higher in the conventional group (1.7% vs. 18% p = 0.004) although the logistic Euroscore was significantly higher 6.8% ± 5.4 vs. 3.6% ± 1.6. Conclusions: Minimally invasive mitral valve surgery is safe and feasible in selected patients with good medium and long-term echocardiographic follow-up.
Highlights
Left untreated, severe mitral regurgitation (MR) carries a poor prognosis
The International Society of Minimally Invasive Cardiac Surgery published a consensus document in 2010 highlighting the lack of data directly comparing the two techniques, and strongly recommended more studies designed to help determine whether minimally invasive mitral valve repair (MiMVR) is better, worse or the same as conventional surgery with respect to important clinical outcomes [11]
Further mitral valve intervention in 4 cases (12%) who underwent conventional surgery (recurrent MR (3 cases), worsening coronary disease requiring coronary artery bypass grafting with further MV repair for moderate MR (1 case))
Summary
Severe mitral regurgitation (MR) carries a poor prognosis. In asymptomatic patients, estimated 5-year rates of death from any cause, death from cardiac causes and adverse events (death, heart failure or new atrial fibrillation (AF)) are 22%, 14%, and 33% respectively [1]. The first video-assisted minimally invasive mitral valve repair via a lateral thoracotomy was reported in 1996 [8]. Such “keyhole” techniques were pioneered to reduce postoperative pain, blood loss, hospital stays and cost compared to the conventional median sternotomy approach [9] [10]. The International Society of Minimally Invasive Cardiac Surgery published a consensus document in 2010 highlighting the lack of data directly comparing the two techniques, and strongly recommended more studies designed to help determine whether minimally invasive mitral valve repair (MiMVR) is better, worse or the same as conventional surgery with respect to important clinical outcomes [11]. We compare clinical and echocardiographic follow-up of our real-world experience of conventional approach versus MiMVR in consecutive patients at a single centre
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
