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OBJECTIVE:
Right lateral mini-thoracotomy is an increasingly used approach for mitral valve surgery (MVS). We report our experience with minimally invasive MVS and evaluate short-term surgical outcomes of morbidity and mortality, as well as results of 1-year-follow-up and rates of reoperation.
METHODS:
Between 8/2009 and 11/2011, minimally invasive MVS was performed in 163 patients. Mean age was 62.6±13.2 years. Mean preoperative left ventricular ejection fraction (EF) was 60.8±10.8 %. In all cases, surgical access was a right lateral mini-thoracotomy. Reconstructions were performed in 139 patients (85.3 %). An annuloplasty by ring or band was incorporated into 135 (82.82 %) of 139 repairs (ring: 67, band: 68 cases). 24 valves (14.7 %) were replaced.
RESULTS:
In-hospital mortality was 3.7 % (6 of 163). Duration of operation, CPB and cross-clamp times were 232±68 min, 153,7±39.7 min, and 87.3±36.8 min, respectively. A conversion to sternotomy was necessary in 2 patients (1.2%). 8 patients (4.9%) underwent re-exploration for bleeding. ICU- and hospital-stay were 2.0±2.2 days and 14.5±7.4 days, respectively.
Further peri-operative morbidity included new onset atrial fibrillation (3.5 %), stroke (4.8 %), and wound healing complications (2.4 %).
At one year follow-up, survival was 95.7 % and freedom from re-operation was 94.6 %. Mean grade of mitral regurgitation decreased from 3.8 to 1.4 (p < 0.05). At follow-up, mean EF was 59.4 ± 7.4 % (p > 0.05 vs. pre-OP).
CONCLUSIONS:
Our results demonstrate that minimally invasive MVS allows for a safe reconstruction of MV in the majority of the patients, with excellent midterm results and a low incidence of perioperative morbidity or recurrent mitral regurgitation.