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Objective:
Minimally invasive approaches have been used with increasing frequency for heart valve repair and replacement surgery over the past 20 years. Some have expressed concern, however, that minimal invasive techniques may lead to inferior results, particularly for mitral valve (MV) surgery.
Material and Methods:
Between March 1992 and February 2010, a total of 386 patients underwent minimal invasive MV surgery for MR at our institution using a right lateral mini-thoracotomy and femoral cannulation for cardiopulmonary bypass. Of these, a total of 348 (90.2%) patients underwent MV repair. The mean grade of preoperative MR was 3.3; 0.6, age was 66.3; 12.7 years, ejection fraction was 59.2; 15.1% and 201 patients (52.1%) were male.
Results:
The procedure was successfully performed in all but one patient (0.26%) who required intraoperative conversion to full sternotomy. MV repair techniques consisted of ring annuloplasty with or without chordae-replacement or Carpentier-type leaflet resection. 107 patients (27.7%) had undergone previous median sternotomy for coronary or valvular disease. Concomitant procedures consisted of atrial fibrillation ablation in 124 patients (32.1%), tricuspid valve surgery in 12 patients (3.1%), and patent foramen ovale/atrial septal defect closure in 31 patients (8%). Mean duration of CPB was 107 min and mean aortic cross-clamp time was 73 min. Thirty-day mortality was 2.3%. Follow-up was performed in 99% of patients at an average of 23.9 months postoperatively.
Conclusions:
Minimally invasive MV repair via small anterolateral thoracotomy, along with certain concomitant procedures, can be performed in the vast majority of patients with MR. Our large series demonstrates that these procedures can be performed with low perioperative complication rates and excellent durability.