title: Minimally invasive mitral valve surgery can be performed with optimal outcomes in the presence of left ventricular dysfunction.
abstract: BACKGROUND
  Minimally invasive approaches to mitral valve repair have demonstrated equivalent technical outcomes and more rapid recovery when compared with traditional sternotomy. These techniques have been widely accepted for mitral insufficiency and stenosis. The utilization of minimally invasive techniques in the presence of left ventricular (LV) dysfunction has been controversial. We hypothesized that minimally invasive mitral valve surgery could be safely performed in the presence of compromised myocardial function, thereby minimizing recovery time.
  
  
  METHODS
  All patients undergoing minimally invasive mitral valve surgery at our center from November 1998 through June 2012 were analyzed. During this time 1,103 patients underwent minimally invasive, port access, mitral valve surgery utilizing a video-assisted limited right thoracotomy approach. Patients with LV dysfunction (ejection fraction ≤ 0.40, n = 140) were compared with patients with normal ventricular function (n = 963). Preoperative, intraoperative, and postoperative variables were compared between cohorts.
  
  
  RESULTS
  Patients with LV dysfunction were able to undergo mitral valve surgery with minimal mortality (2.1% vs 1.7%, p = 0.7) and morbidity, that was comparable with patients with normal ventricular function. Postoperative recovery was only slightly longer compared with patients with normal LV function as noted by time to extubation (6.0 vs 7.0 hours, p = 0.005) and hospital length of stay (7.0 vs 6.0 days, p < 0.001). A significant percentage of patients with LV dysfunction underwent redo cardiac surgery (40.0%) through minimally invasive approaches.
  
  
  CONCLUSIONS
  Minimally invasive, port-access, mitral valve surgery can be safely performed with minimal morbidity and mortality in the presence of cardiomyopathy. This approach may be considered in patients with isolated mitral valve pathology and LV dysfunction in an experienced center.
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Pavan
authors.initials: P
authors.lastname: Atluri
authors.forename: Y Joseph
authors.initials: YJ
authors.lastname: Woo
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Goldstone
authors.forename: Jeanne
authors.initials: J
authors.lastname: Fox
authors.forename: Michael A
authors.initials: MA
authors.lastname: Acker
authors.forename: Wilson Y
authors.initials: WY
authors.lastname: Szeto
authors.forename: W Clark
authors.initials: WC
authors.lastname: Hargrove
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D008944:Mitral Valve Insufficiency / Q000150:complications* / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000150:complications* / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications*
keywords: 28; 35