Ten Years' Follow-Up of Single-Surgeon Minimally Invasive Reparative Surgery for Degenerative Mitral Valve Disease

Objective: Granted that minimally invasive mitral valve (MV) surgery short-term results were found to be equivalent to those achieved with traditional sternotomy with respect to perioperative morbidity and echocardiographic outcomes, little is known about the long-term efficacy of this approach. This report analyzes a 10-year single-surgeon experience with minimally invasive MV surgery through a right minithoracotomy with peripheral cannulation and external aortic cross-clamping and MV repair (MVR) by direct vision. Methods: We studied 179 patients (48% female) who underwent MVR between December 1999 and December 2010. Mean age was 40.2 T 10.1 years (range, 15Y67 years). One hundred seventy patients (95.0%) had degenerative diseases, and nine patients (5.0%) had endocarditic diseases. Repair techniques for degenerative disease with posterior leaflet prolapse (74 patients, 43.5%) consisted of quadrangular resection (QR) and annuloplasty (AP) combined with sliding plasty (49 patients, 58.1%); for anterior leaflet prolapse (28 patients, 16.5%) and bileaflet prolapse (66 patients, 38.8%), edge-to-edge repair (EE) and AP; in 2 patients (1.2%), annular dilatation alone consisting of AP. Repair techniques for endocarditic disease consisted of EE in six patients (66.7%), perforation closure in two patients (22.2%), and QR combined with AP in one patient (11.1%). Results: All patients survived the operation and were discharged with MV regurgitation (MR) less than 2+/ 4+. At 10 years' follow-up, overall survival was 98.7% T 1.2%, freedom from redo was 98.5% T 1.1%, freedom from MR recurrence (92+/ 4+) in QR and in EE repair were, respectively, 91.7% T 2.2% and 90.0% T 2.4% (P = not significant). The linearized rates of overall mortality, MRrecurrence (92+/ 4+), and redo at follow-up are 0.10% T 0.10% per year, 0.63% T 0.26% per year, and 0.21% T 0.15% per year, respectively. Conclusions: Minimally invasive MVR can be performed with very good perioperative and long-term results. Freedom from MR greater than 2+/ 4+ recurrence for patients with QR is equivalent to that with EE repair in our patient cohort.