Very high repair rate using minimally invasive surgery for the treatment of degenerative mitral insufficiency.
BACKGROUND
Minimally invasive mitral valve surgery (MIMVS) is an established alternative to median sternotomy for mitral valve repair. However, this technique has yet to gain widespread adoption, partly because of concerns that this approach might yield lower repair rates or repairs that are less durable than those performed through a sternotomy. The purpose of this study was to report our inaugural experience with MIMVS, with a focus on mitral valve repair rate and midterm outcomes.


METHODS
Between May 2006 and April 2012, minimally invasive mitral valve repair was attempted in 200 consecutive patients with degenerative mitral disease. The approach used was a 4- to 5-cm right anterolateral minithoracotomy with femorofemoral cannulation for cardiopulmonary bypass. Mean follow-up was 2.9 ± 1.8 years, and follow-up was 99% complete.


RESULTS
The mitral valve was successfully repaired in all but 2 patients, yielding a repair rate of 99%. Hospital mortality occurred in 2 patients (1%). Intraoperative conversion to sternotomy was necessary in 12 patients (6%), including 1 of the 2 unsuccessful repairs. Mean cardiopulmonary bypass and aortic cross-clamp times were 130.8 ± 41.3 minutes and 104.8 ± 35.6 minutes, respectively. Median hospital stay was 5 days. The 5-year survival and freedom from reoperation were 97.9% ± 1.5% and 98.1% ± 1.3%, respectively.


CONCLUSIONS
A very high repair rate can be achieved using MIMVS for the treatment of degenerative mitral regurgitation, including during the learning phase. Midterm survival and freedom from valve-related reoperation are excellent. MIMVS is a safe and effective alternative to mitral valve repair through a sternotomy.
Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada; Department of Cardiac Surgery, Montreal Heart Institute, Montreal, Québec, Canada.
Amine
A
Mazine
Department of Cardiac Surgery, Montreal Heart Institute, Montreal, Québec, Canada; Department of Cardiac Surgery, Pavia University School of Medicine, Pavia, Italy.
Nicola
N
Vistarini
Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada; Department of Cardiac Surgery, Montreal Heart Institute, Montreal, Québec, Canada.
Aly
A
Ghoneim
Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada; Department of Anesthesiology, Montreal Heart Institute, Montreal, Québec, Canada.
Jean-Sébastien
JS
Lebon
Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada; Department of Cardiac Surgery, Montreal Heart Institute, Montreal, Québec, Canada.
Philippe
P
Demers
Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada; Department of Cardiac Surgery, Montreal Heart Institute, Montreal, Québec, Canada.
Hugues
H
Jeanmart
Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada; Department of Cardiac Surgery, Montreal Heart Institute, Montreal, Québec, Canada.
Michel
M
Pellerin
Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada; Department of Cardiac Surgery, Montreal Heart Institute, Montreal, Québec, Canada. Electronic address: denis.bouchard@icm-mhi.org.
Denis
D
Bouchard
D000328:Adult; D000367:Age Factors; D006328:Cardiac Catheterization / Q000379:methods; D002315:Cardiopulmonary Bypass / Q000379:methods; D015331:Cohort Studies; D018572:Disease-Free Survival; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D008943:Mitral Valve / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000379:methods* / Q000401:mortality*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D061646:Operative Time; D061214:Patient Safety; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D013908:Thoracotomy / Q000379:methods* / Q000706:statistics & numerical data*; D013997:Time Factors; D016896:Treatment Outcome