Midterm Outcomes Of A Single Center In Minimally Invasive Mitral Valve Surgery
Timmy Wing kuk Au, Inderjeet Bhatia, Cally Ka Lai Ho, Daniel Tai Leung Chan.
Department of Cardiothoracic Surgery, Queen Mary Hospital, Hong Kong, Hong Kong.
Background Mitral valve surgery using minimally invasive approach is becoming the new standard for mitral valve surgery. Minimally invasive mitral valve surgery (MIMVS) was initiated at our center in 2006 and has gained pace since 2012. This study was conducted to review our MIMVS results to examine the feasibility, safety, and effectiveness in our local population over a 9- year period. Methods From 2010 to 2018, 222 patients underwent MIMVS at our institution. Results The mean age was 52 ± 11 years, 103 were female. The median EuroSCORE II was 1.1%. 169 patients received mitral surgery via mini thoracotomy (n=192), robotic assisted (n=29), hemi sternotomy (n=1). 165 underwent valve repair and 57 underwent valve replacement. The predominant pathology was degenerative for repair and rheumatic for replacement. Repair techniques included annuloplasty (96%), leaflet resection (32%) and artificial chordae implantation (30%). Mechanical and biological prosthesis was implanted in 44 (66 %) and 13 (19 %), respectively. Concomitant procedures were undertaken in 87 (39%) and atrial ablation was the most commonly performed additional procedure. The mean CPB time and aortic cross clamp time were 159 ± 47 and 122 ± 41 minutes respectively. There was 1 in-hospital mortality (0.5%). Postoperative complications included reoperation for bleeding or tamponade in 11 (5%) and transient stroke in 2 (0.9%). Median ICU stay and hospital stay was 1 and 9 days respectively. The mean follow up duration was 45 ± 27 months. At a mean of 65 ± 24 months there were 5 reoperations, after repair and none after replacement. There were 3 late deaths and all were due to non-cardiac causes. Overall survival was 99%, 98% and 96%; freedom from reoperation after mitral valve repair was also 99%, 98% and 92%; freedom from mitral regurgitation (≥ 2+) was 97%, 90% and 90% at 1, 5 and 9 years respectively. Conclusion In appropriately selected patients mid-term clinical outcomes of MIMVS are excellent. These procedures are safe and effective with low morbidity and mortality. We advocate minimally invasive approach and expect more patients will benefits from it.
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