title: Minimally invasive mitral valve repair as a routine approach in selected patients.
abstract: OBJECTIVE
  To report our experience with minimally invasive mitral valve repair.
  
  
  METHODS
  From 1999 to 2003,104 patients underwent mitral valve repair through a right anterolateral minithoracotomy. Most of them were in New York Heart Association functional class I-Il, had normal ejection fraction and were in sinus rhythm. Eighty-five patients suffered from severe mitral regurgitation due to degenerative disease (n = 82) or healed endocarditis (n = 3) and 19 patients had severe mitral stenosis. Sixty-two patients underwent edge-to-edge repair due to anterior/bileaflet prolapse, 23 had a quadrangular resection of the posterior leaflet and 19 a commissurotomy.
  
  
  RESULTS
  No conversions to sternotomy were necessary. Mean cardiopulmonary bypass and aortic cross-clamp times were 75 +/- 14 and 54 +/- 8 min, respectively. Median mechanical ventilation and intensive care unit stay times were 6 and 13 h, respectively. No in-hospital deaths and no major postoperative complications occurred. At a mean follow-up of 27.4 +/- 10.6 months, all patients but two were in New York Heart Association functional class I. The survival rate was 100% and freedom from reoperation was 95.2 +/- 3.3% at 4 years. No or mild residual mitral regurgitation was detected at echocardiography in 100 patients (96%) and moderate insufficiency was found in two (1.9%). The degree of satisfaction in terms of cosmetic result and postoperative discomfort was very high.
  
  
  CONCLUSIONS
  Mitral valve repair can be effectively performed through a minimally invasive approach achieving excellent mid-term results and a high degree of patient satisfaction in terms of comfort, cosmetic result and prompt recovery. At our institution, this approach has now become the standard procedure for mitral valve disease in young and active patients.
authors.affiliation: Department of Cardiac Surgery, San Raffaele University Hospital, Via Olgettina 60, 20132 Milan, Italy. torracca.lucia@hsr.it
authors.forename: Lucia
authors.initials: L
authors.lastname: Torracca
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Lapenna
authors.forename: Michele
authors.initials: M
authors.lastname: De Bonis
authors.forename: Samer
authors.initials: S
authors.lastname: Kassem
authors.forename: Giovanni
authors.initials: G
authors.lastname: La Canna
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Crescenzi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Castiglioni
authors.forename: Antonio
authors.initials: A
authors.lastname: Grimaldi
authors.forename: Ottavio
authors.initials: O
authors.lastname: Alfieri
mesh_terms: D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000601:surgery*; D011183:Postoperative Complications; D015996:Survival Rate; D016896:Treatment Outcome