title: Impact of timing and surgical approach on outcomes after mitral valve regurgitation operations.
abstract: BACKGROUND
  This study investigated whether the timing of mitral valve (MV) repair or surgical approach affects outcomes in patients with MV regurgitation.
  
  
  METHODS
  Between 1992 and 2009, 2,255 patients underwent MV operations, including 1,305 with isolated MV regurgitation operations (1,054 repairs, 251 replacements). Surgical approaches were sternotomy in 377, video-assisted right minithoracotomy in 481, or robot-assisted in 447. Mean follow-up was 6.4±4.5 years (maximum, 19 years).
  
  
  RESULTS
  Sternotomy MV repairs decreased during the study while minimally invasive MV repairs increased. Robotic MV repair patients were younger, with fewer women, had better left ventricular ejection fractions, and were more likely to have myxomatous degeneration (all p<0.001). The robotic approach led to a higher MV repair rate and increased use of leaflet/chordal procedures but had longer cardiopulmonary bypass and aortic cross-clamp times (all p<0.001). The 30-day mortality for isolated MV repair was similar for all approaches (p=0.409). Fewer neurological events were observed in the videoscopic and robotic groups (p=0.013). Adjusted survival was similar for all approaches (p=0.357). Survival in patients in New York Heart Association class I to II with myxomatous degeneration or annular dilatation was similar to a matched population but was worse for patients in class III to IV or undergoing MV replacement.
  
  
  CONCLUSIONS
  MV repair in patients with severe MV regurgitation should be performed before New York Heart Association class III to IV symptoms develop. Minimally invasive MV repair techniques render similar outcomes as the sternotomy approach.
authors.affiliation: Division of Cardiac Surgery, Montreal University Hospital Center, Montreal, Quebec, Canada.
authors.forename: Louis-Mathieu
authors.initials: LM
authors.lastname: Stevens
authors.forename: Evelio
authors.initials: E
authors.lastname: Rodriguez
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Lehr
authors.forename: Linda C
authors.initials: LC
authors.lastname: Kindell
authors.forename: L Wiley
authors.initials: LW
authors.lastname: Nifong
authors.forename: T Bruce
authors.initials: TB
authors.lastname: Ferguson
authors.forename: W Randolph
authors.initials: WR
authors.lastname: Chitwood
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D058385:Cardiac Valve Annuloplasty / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012371:Robotics / Q000379:methods*; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D056346:Sternotomy / Q000379:methods; D016019:Survival Analysis; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods; D013908:Thoracotomy / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome