title: Ten years' follow-up of single-surgeon minimally invasive reparative surgery for degenerative mitral valve disease.
abstract: 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 ± 10.1 years (range, 15-67 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% ± 1.2%, freedom from redo was 98.5% ± 1.1%, freedom from MR recurrence (>2+/4+) in QR and in EE repair were, respectively, 91.7% ± 2.2% and 90.0% ± 2.4% (P = not significant). The linearized rates of overall mortality, MR recurrence (>2+/4+), and redo at follow-up are 0.10% ± 0.10% per year, 0.63% ± 0.26% per year, and 0.21% ± 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.
authors.affiliation: Division of Cardiac Surgery, Presidio Lancisi, Ospedali Riuniti, 60020 Ancona, Italy. a.dalfonso@virgilio.it
authors.forename: Alessandro
authors.initials: A
authors.lastname: D'Alfonso
authors.forename: Filippo
authors.initials: F
authors.lastname: Capestro
authors.forename: Carlo
authors.initials: C
authors.lastname: Zingaro
authors.forename: Sacha
authors.initials: S
authors.lastname: Matteucci
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Rescigno
authors.forename: Lucia
authors.initials: L
authors.lastname: Torracca
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D015331:Cohort Studies; D004696:Endocarditis / Q000175:diagnosis / Q000601:surgery*; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007558:Italy; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D058386:Mitral Valve Annuloplasty / Q000379:methods; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000601:surgery*; D008945:Mitral Valve Prolapse / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D055502:Secondary Prevention; D016896:Treatment Outcome