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OBJECTIVE: Minimally invasive mitral valve (MIMV) surgery is technically challenging with a long learning curve. We examined the evolution of repair techniques in a new program.
METHODS: MIMV surgery at our institution is performed through a 6cm right anterior minithoracotomy. We examined prospectively collected data on all patients undergoing MIMV between March 2011 and December 2014. Data are presented as medians (interquartile range).
RESULTS: 99 patients had MIMV procedures during this period. Median age was 61 (53 to 68) years, 31 (31%) were female, 2 were reoperations. The repair rate for degenerative and functional disease was 94% (84 of 89 patients) with no/trivial residual MR (n=82, 98%) or mild MR (n=2, 2%) on the intra-operative echo. All rheumatic valves were electively replaced. Twenty (20%) patients underwent concomitant procedures: cryomaze (n=13), patent foramen ovale closure (n=6), tricuspid valve repair (n=3). Bypass and clamp times were 196 (170 to 221) and 132 (111 to 150) minutes respectively. There was one conversion to sternotomy for mild residual MR found after femoral decannulation; this patient left hospital 6 days later with no regurgitation. There was no mortality and no strokes. Duration of ventilation, ITU and hospital stay were 8 (6-10) hours, 2 (1-3) and 6 (5-8) days respectively. When examined by tertile, the use of GoreTex loops increased significantly as the programme progressed (p<0.001) while resective techniques declined (p<0.001).
CONCLUSIONS: High rates of valve repair are achievable with minimally invasive mitral surgery. There has been a significant change in the repair techniques employed as the program developed.