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A Simplified Minimally Invasive Technique Operation for Mitral Valve Repair: Better with Less Risk.
Marco Diena1, Gheorghe Cerin2, Philippe Caimmi3, Gabriele Musica3, Angelo Romano4, Edmond Stelian4, Eugenio Novelli5, Gian Luca Martinelli3, Ugo Tesler6.
1Cardioteam Foundation, Torino, Italy, 2Dept. of Cardiology, San Gaudenzio Clinic, Novara, Italy, 3Dept. of Cardiac Surgery, San Gaudenzio Clinic, Novara, Italy, 4Dept. of Cardiac Anaesthesia, San Gaudenzio Clinic, Novara, Italy, 5Dept. of Statistics, San Gaudenzio Clinic, Novara, Italy, 6Dept. of Cardiac Surgery, Novara, Italy.

OBJECTIVE: mitral valve repair (MVR) has been proved to be the best treatment of mitral regurgitation in degenerative disease . Repair rate is high in dedicated centers through sternotomy. Right minithoracotomy is an appealing approach because of its minimal surgical trauma but entails more technical difficulties. A Simplified Minimally Invasive Technique (SMIT) allows an easier approach with a smooth learnig curve. Here we analize our experience with SMIT operation for elective MVR.
METHODS: from january 2009 to January 2015 we operated on 262 patients (mean age 55.7 ±12) for degenerative prolapse or flail with the SMIT procedure: 1) chest opening in the 3rd intercostal space 2) insertion of a percutaneous venous cannula in the femoral vein 3) direct cannulation of the ascending aorta 4) a flexible aortic cross-clamp applied through the skin incision 5) antegrade cardioplegic arrest with crystalloid solution.
RESULTS: there were no technical complications related to the perfusion technique and/or surgical access. Repair rate was 99.6% (261 Pts), a second pump run was necessary in 2.67% of pts (7 Pts). Hospital mortality rate was 0.38% (1Pts) but not related to the operative technique. We had three conversion to sternotomy (1,1%). No patient had a low output syndrome or a poor myocardial protection or wound infections. Mean follow up was 3.6±1.6 years (range 1.2-6.9). Actuarial freedom from reoperation at six years was 100%, actuarial freedom from > 2+ mitral regurgitation recurrence at six years was 96.8%, actuarial freedom from valve endocarditis 100%, actuarial freedom from AF at six years was 82.1%, global survival at six years was 97.9%. NYHA class ≤2 at six years is present in 92,4% of Pts. Overall freedom from event 77.7% at six years ( CI 95% range 5.4-6.5).
CONCLUSIONS: the MVR with SMIT operation provides a less invasive and easier approach with a very high repair rate. We recommend SMIT operation for every new program for minimally invasive MVR.

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