title: Single-centre experience of mitral valve surgery via right lateral mini-thoracotomy in octogenarians.
abstract: OBJECTIVE
  According to demographic changes in the industrialized world, the average age of patients referred to cardiac surgery is increasing. These patients typically display numerous comorbidities, associated with increased perioperative risk. Therefore, the indication for a catheter-based therapy is progressively extended, including interventions on the mitral valve (MV). In this context, we evaluated a contemporary series of octogenarians undergoing minimally invasive MV surgery at our institution using right lateral minithoracotomy to elucidate the preoperative risk profile and the postoperative course in this particular cohort.
  
  
  METHODS
  Between October 2009 and October 2014, 34 patients aged 80 years and older (82.5 ± 2.0) undergoing minimally invasive MV surgery were identified with a subgroup of 15 patients (44.1%) receiving concomitant surgery on the tricuspid valve (TV). We analysed the preoperative profile, perioperative course and functional outcome.
  
  
  RESULTS
  Preoperative comorbidities included insulin-dependent diabetes mellitus (17.6%), COPD (17.6%), active endocarditis (2.9%) and previous neurological events (2.9%). The mean left ventricular ejection fraction was 59.7 ± 6.9%. Mean European System for Cardiac Outcome Risk Evaluation II was 5.2 ± 5.3%. The repair rate of all treated MVs and TVs in isolated and combined procedures was 81.6% (73.5% for MV and 100.0% for TV surgery). Postoperatively, 4 patients (11.8%) required new-onset intermittent haemodialysis. Prolonged ventilation (>12 h) was necessary in 9 patients (26.5%). The 30-day mortality rate was 5.9%.
  
  
  CONCLUSIONS
  Minimally invasive right lateral MV surgery in octogenarians results in favourable outcomes. Therefore, MV surgery represents a valid option in this cohort, providing established and durable concepts of valve reconstruction.
authors.affiliation: Department of Cardiovascular Surgery, University Hospital, Duesseldorf, Germany.
authors.forename: Jan-Philipp
authors.initials: JP
authors.lastname: Minol
authors.affiliation: Department of Cardiovascular Surgery, University Hospital, Duesseldorf, Germany payam.akhyari@med.uni-duesseldorf.de.
authors.forename: Payam
authors.initials: P
authors.lastname: Akhyari
authors.affiliation: Department of Cardiovascular Surgery, University Hospital, Duesseldorf, Germany.
authors.forename: Udo
authors.initials: U
authors.lastname: Boeken
authors.affiliation: Department of Cardiac Surgery, Asahikawa Medical University, Hokkaido, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kamiya
authors.affiliation: Department of Cardiovascular Surgery, University Hospital, Duesseldorf, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Weinreich
authors.affiliation: Department of Anaesthesiology, University Hospital, Duesseldorf, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Sixt
authors.affiliation: Department of Cardiovascular Surgery, University Hospital, Duesseldorf, Germany.
authors.forename: Hildegard
authors.initials: H
authors.lastname: Gramsch-Zabel
authors.affiliation: Department of Cardiovascular Surgery, University Hospital, Duesseldorf, Germany.
authors.forename: Artur
authors.initials: A
authors.lastname: Lichtenberg
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D006435:Renal Dialysis; D012121:Respiration, Artificial; D012307:Risk Factors; D013908:Thoracotomy / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000601:surgery
keywords: Minimally invasive surgery; Mitral valve; Octogenarians