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Early Outcomes in Minimally Invasive Mitral Valve Surgery and Depressed Ejection Fraction: A 8-year Experience.
Antonio Miceli, Michele Murzi, Matteo Ferrarini, Raffaele FugÓ, Simone Simeoni, Alfredo G. Cerillo, Stefano Bevilacqua, Pier A. Farneti, Marco Solinas, Mattia Glauber. Fondazione Toscana G. Monasterio, Massa, Italy.

OBJECTIVE: The beneficial effect of minimally invasive mitral valve surgery (MIMVS) has been well documented in patients with normal left ventricular ejection fraction (LVEF). However, few studies have examined outcomes of MIMVS in patients with depressed LVEF. The aim of our study was to evaluate our experience with MIMVS in patients with LVEF <35%.
METHODS: From June 2004 to December 2012, 1240 patients underwent MIMVS. Of these, 63 patients had a LVEF<35%.
RESULTS: Thirty-day mortality was 1.6% with a median predicted EuroSCORE of 14 (interquartile range [IQ] 8-18). Mean age was 69▒10 years and mean LVEF was 32▒3%. Seven patients (11%) had redo surgery. Functional mitral regurgitation (MR) was present in 30 patients (47%) and degenerative MR in 24 patients (38%). Two patients required surgery for active endocarditis and 3 patients had prostheses mitral valve dysfunction. Thirty-five patients (53%) underwent mitral valve replacement and 28 (44%) patients underwent mitral valve repair. Combined procedure were: tricuspid repair (n=6,10%) and atrial fibrillation surgery (n=4, 6%). The median ventilation time was 10 hours (IQ range 6-20), as well as the median for intensive care unit and hospital stay was 2 day (IQ range 1-3) and 7 (IQ range 6-9). Two patients had a postoperative stroke, incidence of postoperative atrial fibrillation and blood transusion was 30% (n=19) and 16% (n=10).
CONCLUSIONS: Minimally invasive mitral valve surgery in patients with depressed LVEF is a safe approach and can be achieved with low operative mortality and morbidity.


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