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OBJECTIVE: Stated that minimally invasive mitral valve (MV) surgery short-term results were found to be equivalent to those achieved with traditional sternotomy with respect to perioperative morbidity and echocardiographic outcomes, little is known about the long-term efficacy. This report analyzes a single surgeon's results over 10 years with minimally invasive MV surgery via right minithoracotomy, peripheral cannulation, external aortic clamping and surgery under direct vision.
METHODS: We studied 179 patients (48% female) who underwent MV surgery between December 1999 and December 2010. Mean age was 40.2±10.1 years (range 15-67 years). 170 patients (95.0%) had degenerative and 9 (5.0%) healed endocarditic diseases. Repair techniques for degenerative disease with posterior leaflet prolapse (74 patients, 43.5%) consisted in quadrangular resection (QR) and anuloplasty (AP) combined with sliding (49 patients, 58.1%); for anterior leaflet prolapse (28 patients, 16.5%) and bileaflet prolapse (66 patients, 38.8%) consisted in edge-to-edge repair (EE) and AP and in 2 patients (1.2%) with only anular dilatation consisted in AP. Repair techniques for healed endocarditic disease consisted in EE in 6 patients (66.7%), perforation clousure in 2 patients (22.2%) and QR in 1 patient (11.1%) combined with AP.
RESULTS: All patients survived the operation and were discharged with MV regurgitation (MR) <2+/4+. Overall survival, freedom from re-do and MR recurrence (>2+/4+) in QR and EE repair, determined by Kaplan-Meier analysis, and linearized rates of MR recurrence (>2+/4+) and redo at follow-up are reported in the picture.

CONCLUSIONS: Minimally invasive MV surgery can be performed with very good perioperative and long-term results. Freedom from MR >2+/4+ recurrence for patients with QR is equal to that with EE repair in our patient cohort.