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OBJECTIVE: In the UK we were an early adopter of minimally invasive mitral valve repair surgery (Mini-MVR). We established a dedicated multidisciplinary team (including one surgeon) who underwent training and initiated the program with proctor support. Over the next ten years, we felt consistency was maintained in the surgical technique and team - except experience (which grew). We sought to determine how maturation of the program impacted on patient outcome.
METHODS: We retrospectively reviewed our institutional database for all patients who underwent isolated Mini-MVR (2003-2013). Outcomes of the first 95 (Period 1) were compared to second 95 cases (Period 2). The data was analysed using IBM SPSS v.22.0 for Mac. Statistical significance was defined as a p value of &lt 0.05.
RESULTS: There was no difference in pre-operative demographics or risk profile (mean logistic EuroSCORE 3/ 3.5, p=0.54 for Period 1/ 2 respectively). However there was a significant reduction in aortic cross-clamp times (112/ 104 minutes, p=0.02) and cardiopulmonary bypass (160/ 146, p= &lt0.001). Post-operative complications were similar (e.g. stroke 3.2%/ 0%, p=0.12 and 30-day mortality 2.1%/ 0%, p=0.50). There was a reduction in the mean post-operative length of stay (7.8/ 6.3 days, p &lt0.001) and the proportion of patients discharged on or before day 4 (32.3%/ 57.9%, p=0.005). Importantly, fewer patients left hospital with mitral regurgitation in Period 2(=&gt moderate mitral regurgitation was 6.6% (6 patients)/ 1.1%, p=0.002).
CONCLUSIONS: Reassuringly, post-operative complications and mortality were similar between the two cohorts. Increased operative times and hospital stay were however additional burdens in Period 1. The quality of repair improved over time but the number of patients adversely affected was small. Quantifying the impact can inform patients and aid decision-making in newly established programs.