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OBJECTIVE:
We sought to review our experience in patients with severely impaired left ventricular function (ejection fraction ≤ 30 %) who underwent minimally invasive mitral valve (MV) surgery.
METHODS:
Between 1999 and 2010 a total of 3450 patients underwent minimally invasive MV surgery. Of these patients, 177 suffered from severely impaired left ventricular function (EF < 30%, including ischemic and non-ischemic cardiomyopathy). Primary indication for surgery was MV regurgitation in all patients, whereas five patients were diagnosed with additional stenosis. Mean age of patients was 67±11 years and 110 were male. Mean EUROScore was 13.6 ± 11.
RESULTS:
MV repair was accomplished in 86.4 % of patients (n = 153) and MV replacement was necessary in 13.6 % (n = 24). Primary MV repair included the implantation of an annuloplasty ring in all patients (complete rings including amongst others the Physio and ETLogix ring in 146 patients, with mean size of 29.5 ± 2.2) and additional procedures like chordae replacement in several patients. Concomitant procedures were tricuspid valve surgery in n = 27, atrial ablation in n= 48, and ASD closure in n = 10. Duration of CPB was 123 ± 64 min and aortic-clamp-time was 54 ± 36 min. Thirty-day mortality was 7.9 %. Mean follow-up time was 3 ± 2.5 years, and follow-up was 92 % complete. For the overall group ten year survival was 45.5 % (95% CI: 35.2 - 55.9). The over-all rate of MV-related re-intervention was 4% and heart transplantation in 6%.
CONCLUSIONS:
Minimally invasive MV repair in patients with significantly impaired left ventricular function can be performed with a reasonable operative mortality and acceptable long-term survival for this sick patient cohort.