10-Year Follow-up of 1,829 Patients Undergoing Minimally Invasive Mitral Valve Repair: A Single-Center Experience

Objectives: Within the last decade video-assisted mitral valve surgery via right anterolateral minithoracotomy has become the standard approach for surgical treatment of severe mitral regurgitation (MR) of primary/secondary etiology. We analyzed the preoperative variables, intraoperative data and postoperative results at our institution, retrospectively. After discharge, patients were followed up to assess quality of life and long term hemodynamic results with transthoracic echocardiography.

Methods: Between November 2008 and December 2018, a total of 1,829 patients who presented with primary MR (n = 1,454, 79.5%) or secondary MR (n = 376, 20.5%) underwent video-assisted MV surgery. Mean age was 64.2 ± 12.6 years; 1,150 patients (62.9%) were male. Specific leaflet pathology was isolated posterior mitral leaflet (PML; n = 1,116, 61.0%), isolated anterior mitral leaflet (AML; n = 166, 9.1%), and bileaflet (BL) prolapse (n = 170, 9.3%). Preoperative mean MR grade was 3.1 ± 0.7.

Results: Overall, the MV repair rate was 94.8% (1,733 patients). The best reconstruction rate was seen in PML prolapse with 97.8%. 2.8% had previous cardiac surgery. Repair techniques consisted predominantly of leaflet reconstruction (n = 1,408, 77%) with/without implantation of neochords; leaflet resection (n = 73, 4%), combined with ring annuloplasty. According to the MV pathology 12 different annuloplasty rings were used. A conversion to sternotomy was seen in 1.9%. Concomitant procedures were tricuspid valve surgery (n = 198, 10.8%), left atrial/biatrial ablation (n = 532, 29.1%; n = 45, 2.5%), closure of an atrial septal defect (n = 273, 14.9%) and occlusion of the left atrial appendage (n = 712, 38.9%). Aortic cross-clamp time was 100 ± 35 min. 30-day mortality was 2.2%. Complications included bleeding (8.3%), stroke (2.1%), low-cardiac output (3%), and pacemaker implantation (2.6%). At discharge, echocardiographic examinations revealed excellent valve function with a mean MR grade of 0.3 ± 0.5. The follow-up showed improved quality of life, long durability, and low reoperation rate ( < 2%).

Conclusion: Video-assisted mitral valve surgery allows repair of primary and secondary MR with excellent long-term results. Further analysis of long-term outcomes will be statistically evaluated and presented.

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