Minimally Invasive Mitral Valve Surgery via Right Anterolateral Minithoracotomy: 20 Years’ Experience from a Single Center

Background: Minimally invasive mitral valve surgery (MIC-MVS) using a right anterolateral approach has evolved as the clinical standard since the 1990s. We analyzed long term outcomes with this approach.

Method: All patients receiving MIC-MVS between 1997 and 2017 were included. Patient's age was 55.41 ± 14 years. Descriptive statistics and Kaplan–Meier analyses were performed.

Results: A total of 303 patients (165 females, 54.5%) were included. Among all patients 265 (87%) were operated from 1997 until 2007 and 38 (13%) from 2008 until 2017. Two-hundred-fifty-one patients (82%) received mitral valve reconstructions and 52 patients (18%) mitral valve replacement. The underlying pathology was myxomatous degenerative disease in 78.5% of patients. Conversion to median sternotomy and re-exploration for bleeding was necessary only in 2 (0,6%) and 22 (7%) cases. Only 2 (0,6%) patients suffered from perioperative minor neurological deficit. Thirty-day overall mortality was 3,3% (2% in patients with MV reconstruction vs. 9.6% in patients with MV replacement). Follow-up was complete in 97% (8 patients lost to follow-up) with median of 16.3 years (range: 0.1–23.3 years), and a total of 4,229 patient-years. The overall 10- and 15-year survival was 84 ± 2% and 72 ± 3%. The 10- and 15-year freedom from MV reoperation was 96 ± 1% and 93 ± 2%.

Conclusion: Minimally invasive mitral valve surgery through an anterolateral minithoracotomy is safe and feasible. This technique provides very good early- and especially long-term survival with very high freedom from MV reoperation.

Publikationsverlauf

Artikel online veröffentlicht:
03. Februar 2022