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OBJECTIVE:
Mitral valve surgery through minithoracotomy is technically challenging. The purpose of this study was to assess if a particular surgical strategy was able to reduce the complication rate from the beginning of surgeon experience.
METHODS:
In January 2009 we started to repair the mitral valve through right minithoracotomy using a Simplified Minimally Invasive Technique ( SMIT operation). Cardiopulmonary bypass was achieved through direct ascending aorta cannulation and insertion of a single percutaneous venous cannula in the groin. A flexible aortic cross clamp was applied through the skin incision and cardioplegic arrest was obtained with delivery of antegrade Custodiol® HTK solution. For ten months we treated posterior leaflet prolapse than we extended our indication to more complex lesions involving both leaflets.
RESULTS:
From January 2009 to May 2011 we operated on 100 selected patients with severe degenerative mitral regurgitation. Age was 55.7±11.8 years old (range 27-78). We had one hospital death (1% mortality), not related to the technique. There was one conversion to sternotomy (1%). Valve repair was achieved in all patients and postoperative echocardiogram showed absent or trivial regurgitation in all except for two patients that had 2+ mitral regurgitation. In all cases we abtained a good myocardial protection.
CONCLUSIONS:
A Simplified Minimally Invasive Technique ( SMIT operation) reduces complication rate with a very smooth learning curve in mitral valve repair through minithoracotomy. We recommend this technique for every new program to reproduce the same operation and to achieve same outcomes of standard sternotomy. A stepwise approach is mandatory: a previous experience in conventional mitral valve repair; a multidisciplinary team approach surgeons-echocardiographer; a specific training in dedicated center with proper tutoring.