title: Minimally invasive mitral valve surgery is a very safe procedure with very low rates of conversion to full sternotomy.
abstract: OBJECTIVE
  Over the past 10 years, minimally invasive mitral valve surgery (MI-MVS) has become the standard approach for treatment of atrio-ventricular valve disease in specialized centres. This approach uses a right lateral mini-thoracotomy and femoral cannulation for cardiopulmonary bypass. In a very low number of patients, conversion to full sternotomy may be necessary.
  
  
  METHODS
  A total of 3125 patients underwent MI-MVS between 1999 and 2010 at our institution. Conversion to full sternotomy was required in 1.0% (n=34) of all patients. Patient data, including intraoperative course and postoperative outcome, were collected. Follow-up data were collected in a prospective database and analysed retrospectively.
  
  
  RESULTS
  A total of 34 patients underwent conversion to full sternotomy during MI-MVS. The mean age of patients was 67.9±9.5 years, and 17 patients were female (50%). The main reasons for conversion were as follows: major bleeding in 18 patients (52.9%); severe pulmonary adhesions in six patients (17.6%); and aortic dissection in five patients (14.7%). The clinical outcome of these patients was impaired, with the development of acute renal failure in 13 patients (38.2%) and respiratory failure in 10 patients (29.4%). Operative mortality (30 days) was 23.5% (eight patients). The reason for death in all these patients was low cardiac output syndrome with subsequent multi-organ failure.
  
  
  CONCLUSIONS
  This large series shows that MI-MVS can be performed with very low complication rates. In the experience of this large single-centre study, conversion to full sternotomy was necessary in only 1% of all patients. If conversion is indicated, however, it is associated with a high operative mortality.
authors.affiliation: Department of Cardiac Surgery, Leipzig University Heartcentre, Leipzig, Germany. marcel-vollroth@gmx.de
authors.forename: Marcel
authors.initials: M
authors.lastname: Vollroth
authors.forename: Joerg
authors.initials: J
authors.lastname: Seeburger
authors.forename: Jens
authors.initials: J
authors.lastname: Garbade
authors.forename: Bettina
authors.initials: B
authors.lastname: Pfannmueller
authors.forename: David
authors.initials: D
authors.lastname: Holzhey
authors.forename: Martin
authors.initials: M
authors.lastname: Misfeld
authors.forename: Michael A
authors.initials: MA
authors.lastname: Borger
authors.forename: Friedrich W
authors.initials: FW
authors.lastname: Mohr
mesh_terms: D000368:Aged; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D058386:Mitral Valve Annuloplasty / Q000379:methods* / Q000401:mortality; D008944:Mitral Valve Insufficiency / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D056346:Sternotomy / Q000401:mortality; D020775:Thoracic Surgery, Video-Assisted / Q000401:mortality; D013908:Thoracotomy / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome