BACKGROUND: to evaluate the feasibility of complex mitral repair thru a small right periareolar incision. In particular we want to demonstrate that complex repair with Gore-Tex neochordae is feasible thru right periareolar incision. Methods: in last 5 years we performed 300 cases of mitral repair thru a small right periareolar incision. Direct vision approach was used first in absence of video assistance. After 100 cases we used a video assisted endoscopy. In male patients we moved from a standard minithoracothomy incision to periareolar 5 years ago after performing over 500 procedures in minithoracothomy, and more than 2000 complex mitral repair in full sternothomy. A mean of 2 Gore-Tex (1 to 4) neochordae were used in each patient and for the anuloplasty a Corcym Sovering band ring was used in 50% of cases (150/300), a Corcym Memo 4 D in 20% (60/300) and 30% were treated with Edwards Phisio ring (90/300). An echocardiographic control was performed at the beginning and at the end of the procedure, after one week and three months later in every patient. A pain questionnaire was given to all patients to register and measure the intensity level and duration time. Blood loss and hospital stay were registered and compared to full sternothomy and minithoraotomy. Results: Echocardiographic control showed good results at the end of the procedure for all patients, with 15 patients showing a mild regurgitation and 95% (285/300) free from regurgitation. The same result at discharge (one week echo), at three months 1 patients of the 15 with mild regurgitation showed to have increased to moderate regurgitation probably due to ventricular dilatation and leaflets tethering. Pain intensity resulted less of 20% in periareolar incision despite of minithoracothomy. Blood loss in periareolar incision was 30% inferior (mean 560 cl) to full sternothomy (mean 730 cl) and 5% less than minithoracothomy (mean 580 cl). Hospital stay was comparable to minithoracothomy (mean 6 days) and 2 days shorter than full sternothomy (mean 8 days). Conclusions: Echo follow-up will show us further results in terms of absence of mitral regurgitation, but those obtained since now are comparable with the once we had in minithoracothomy and in full sternothomy. So we can affirm that right periareolar incision for mitral repair is a feasible way to perform a complex repair with good results. In men undergoing mitral repair is an aesthetic incision with favorable results in terms of less pain, low blood loss, and quick recovery.
