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Incremental Improvements in a Minimally Invasive Mitral Repair Program
Sion G. Jones, Kenneth Palmer, Omar Al-Rawi, Paul Modi.
Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.

OBJECTIVE: The learning curve for minimally invasive mitral valve surgery is long. As our program continues to grow, we examine whether there are incremental improvements in patient outcomes.
METHODS: We retrospectively examined a prospectively collected database of all patients in our minimally invasive mitral valve program. Patients were divided into tertiles according to the date of their procedure, and comparison was made between the first and third tertiles. Procedures were performed between March 2011 and November 2015.
RESULTS: A total of 140 minimally invasive procedures were performed in total, of which 114 were minimally invasive mitral valve repairs with or without concomitant procedures. There were no differences between the two groups in terms of baseline characteristics: age (60.2 vs 59.0yrs, p=0.69); female sex (34% vs 34%, p=1.0), Baseline NYHA 3/4 (26% vs 26%, p=1.0), BMI (25.9 vs 25.4, p=0.58), left ventricular ejection fraction <30% (0% vs 2.6%, p=0.3141).
There were no deaths or cerebrovascular complications in either group. Ten patients in the most recent tertile had concomitant procedures (1 tricuspid annuloplasty, 6 cryo ablation, 3 PFO closure, 1 myxoma excision), compared with four (1 tricuspid repair, 3 cryoablation) in the earliest tertile (p=0.076). There was a reduction in cardiopulmonary bypass (210.7±33.2 vs 171.4±32.9 minutes, p<0.0001) and aortic cross clamp time (141.4±29.0 vs 118.3±26.7 minutes, p=0.001) during this study. Post operative bleeding was significantly less in the latter group (414±213 vs 673±422ml, p=0.002). Hospital stay (6.4±3.3 vs 6.4±3.3 days, p=0.94) and intensive care unit stay (2.1±1.5 vs 2.6±1.8 days, p=0.39) did not differ between groups.
CONCLUSIONS: Minimally invasive mitral valve repair is safe. We have seen a reduction in the cross clamp and cardiopulmonary bypass time despite an increase in the number of concomitant procedures performed. The amount of post operative blood loss has also decreased. Despite these changes, we are yet to see a reduction in the intensive care stay or the post operative length of stay.

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