title: Outcomes of minimally invasive mitral valve surgery in patients with an ejection fraction of 35% or less.
abstract: OBJECTIVE
  We evaluated the outcomes of minimally invasive mitral valve surgery via a right anterior thoracotomy approach in patients with isolated severe mitral regurgitation and severely reduced left ventricular systolic function.
  
  
  METHODS
  We retrospectively reviewed all minimally invasive mitral valve surgeries for mitral regurgitation in patients with an ejection fraction of 35% or less performed at our institution between December 2008 and June 2011. The operative times, lengths of stay, postoperative complications, and mortality were analyzed.
  
  
  RESULTS
  We identified a total of 71 patients with severe mitral regurgitation and an ejection fraction of 35% or less who underwent minimally invasive mitral valve surgery. The mean ± SD age was 67 ± 10 years, and 44 of the patients were men (62%). The mean ± SD left ventricular ejection fraction was 27% ± 6%, and 28 patients (39%) had previous heart surgery. The median aortic cross-clamp and cardiopulmonary bypass times were 62 [interquartile range (IQR), 50-80) and 98 minutes (IQR, 92-124), respectively. There was no mitral regurgitation noted in any patient on postoperative transesophageal echocardiogram. The median intensive care unit length of stay was 51 hours (IQR, 42-86), and the median postoperative length of stay was 6 days (IQR, 5-9).
  
  
  CONCLUSIONS
  Minimally invasive mitral valve surgery for severe functional mitral regurgitation in patients with severe left ventricular dysfunction can be performed with a low morbidity and mortality.
authors.affiliation: From the *Division of Cardiac Surgery at Mount Sinai Heart Institute, Miami Beach, FL USA.
authors.forename: Orlando
authors.initials: O
authors.lastname: Santana
authors.forename: Javier
authors.initials: J
authors.lastname: Reyna
authors.forename: Andres M
authors.initials: AM
authors.lastname: Pineda
authors.forename: Christos G
authors.initials: CG
authors.lastname: Mihos
authors.forename: Lior U
authors.initials: LU
authors.lastname: Elkayam
authors.forename: Gervasio A
authors.initials: GA
authors.lastname: Lamas
authors.forename: Joseph
authors.initials: J
authors.lastname: Lamelas
mesh_terms: D000368:Aged; D058385:Cardiac Valve Annuloplasty / Q000379:methods* / Q000401:mortality; D015331:Cohort Studies; D004452:Echocardiography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods / Q000401:mortality; D008943:Mitral Valve / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D012189:Retrospective Studies; D013318:Stroke Volume; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology