title: Minimal invasive mitral valve repair for mitral regurgitation: results of 1339 consecutive patients.
abstract: OBJECTIVE
  Some have expressed concern that minimal invasive mitral valve (MV) repair may not meet the standard of open surgical techniques. We therefore reviewed our results for minimal invasive MV repair for mitral regurgitation (MR).
  
  
  METHODS
  Between March 1999 and February 2007, a total of 1536 consecutive patients underwent minimal invasive MV surgery for MR at our institution using a right lateral mini-thoracotomy and femoral cannulation for cardiopulmonary bypass. Of these, a total of 1339 (87.2%) patients underwent MV repair and these form the focus of this study. The mean grade of preoperative MR was 3.3+/-0.6, age was 60.3+/-12.7 years, ejection fraction was 59.2+/-15.1% and 819 patients (61.2%) were male.
  
  
  RESULTS
  The procedure was successfully performed in all but four patients (0.3%) who required intraoperative conversion to full sternotomy. MV repair techniques consisted of ring annuloplasty with or without chordae-replacement or Carpentier-type leaflet resection. Concomitant procedures consisted of atrial fibrillation ablation in 351 patients (26.2%), tricuspid valve surgery in 80 patients (6.0%), and patent foramen ovale/atrial septal defect closure in 88 patients (6.6%). Mean duration of CPB was 121+/-38min and mean aortic cross-clamp time was 70+/-32min. Thirty-day mortality was 2.4%. Follow-up was performed in 99% of patients at an average of 28.1+/-23.9 months postoperatively. The Kaplan-Meier estimate for survival at 5 years was 82.6% (95% CI: 78.9-85.7%) and for freedom from MV reoperation was 96.3% (95% CI: 94.6-97.4%).
  
  
  CONCLUSIONS
  Minimal invasive MV repair, along with certain concomitant procedures, can be performed in the vast majority of patients with MR. Our large series demonstrates that these procedures can be performed with low perioperative complication rates and very good durability.
authors.affiliation: Department of Cardiac Surgery, Heartcenter, Leipzig University, Struempelstrasse 39, 04289 Leipzig, Germany. j.seeburger@web.de
authors.forename: Joerg
authors.initials: J
authors.lastname: Seeburger
authors.forename: Michael Andrew
authors.initials: MA
authors.lastname: Borger
authors.forename: Volkmar
authors.initials: V
authors.lastname: Falk
authors.forename: Thomas
authors.initials: T
authors.lastname: Kuntze
authors.forename: Markus
authors.initials: M
authors.lastname: Czesla
authors.forename: Thomas
authors.initials: T
authors.lastname: Walther
authors.forename: Nicolas
authors.initials: N
authors.lastname: Doll
authors.forename: Friedrich Wilhelm
authors.initials: FW
authors.lastname: Mohr
mesh_terms: D000368:Aged; D002315:Cardiopulmonary Bypass / Q000379:methods; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000503:physiopathology / Q000601:surgery*; D012086:Reoperation; D013908:Thoracotomy / Q000379:methods; D016896:Treatment Outcome; D016277:Ventricular Function, Left