Minimally Invasive Mitral Valve Surgery In High Risk Patients. Insights Form Single Centre Experience
Mariusz Kowalewski, Jakub Staromłyński, Radosław Smoczyński, Dominik Drobiński, Maciej Bartczak, Anna Witkowska, Michał Pasierski, Mariusz Kujawski, Piotr Suwalski.
CSK MSWiA, Warsaw, Poland.
BACKGROUNDMinimally invasive mitral valve (MIMVS) surgery has become widely accepted alternative to standard sternotomy approach for the treatment of complex MV disease. Despite proven reduction in morbidity, this approach is not routinely performed in high risk patients. The objective of the current report was to report early surgical data as well as remote outcomes of MIMVS with or without concomitant tricuspid valve surgery in unselected high-risk patient population.METHODSBetween 2011 and 2018, 390 patients underwent MIMVS with or without tricuspid valve surgery. Of those, subjects were retrospectively selected as high risk if having met one of following: 1) EuroSCORE >5, 2) Left Ventricle Ejection Fraction (LVEF) <30%, 3) age >80. Right mini-thoracotomy was performed through a 4.0 to 6.0-cm skin incision in the fourth or fifth intercostal space depending on preoperative imaging. Demographics and clinical outcomes were collected and reported for the three respective subgroups. Kaplan-Meier estimates of survival have been analyzed as well with respective annual mortality rates reported for each subgroup.RESULTSMean follow-up was 2.0 year (max 8.0 years). Of all patients undergoing MIMVS, 91 (23.3%) met inclusion criteria and were considered high risk. 51.6% were male, aged 74.7±9.47 with mean EuroSCORE II of 3.6±3.1. Mitral regurgitation was present in 89 (97.8%), MV stenosis in 2 (2.2%), additional tricuspid regurgitation in 39 (42.9%). Mitral valve repair was preferred in 82 (90.1%). MV replacement in 9 (9.9%); PTFE loops and annuloplasty rings were used in all MV repair cases. Cardiopulmonary bypass and aortic cross-clamp time were 160.0 [IQR: 125.0-200.0] minutes and 68.0 [IQR: 58.8-103.0] minutes respectively. Median duration of ICU stay was 4.0 [IQR: 1.9-5.9] days. Thirty-day mortality was estimated at 4.4%. Overall annual mortality rate for all high-risk patients was 9.59%; considered separately, annual mortality rates for subgroups 1) EuroSCORE >5 - 16.15%; 2) LVEF <30% - 6.37%; 3) age >80 y. o. - 8.74%. Over the course of the study, 88 patients (96.7%) were free from re-intrevention.CONCLUSIONSThe study proved that minimally invasive mitral and tricuspid valve surgery performed through mini-thoracotomy incision are feasible and safe even in high risk patients population. 
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