title: Early and long-term outcomes of minimally invasive mitral valve surgery through right minithoracotomy: a 10-year experience in 1604 patients.
abstract: BACKGROUND
  To report early and long-term outcomes of patients undergoing minimally invasive mitral valve surgery (MIMVS) through right mini-thoracotomy (RT) over a 10-year period.
  
  
  METHODS
  From September 2003 to December 2013, a total of 1604 consecutive patients underwent MIMVS through RT.
  
  
  RESULTS
  The mean age was 63 ± 13 years, 770 (48 %) patients were female and 218 (13.6 %) had previous cardiac operations. The most predominant pathology was degenerative disease (70 %), followed by functional mitral valve regurgitation (12 %), rheumatic disease (9.4 %), endocarditis (5 %) and prosthetic dysfunction (3.2 %). Mitral valve repair was performed in 1137 (71 %) patients and 476 (29 %) had mitral valve replacement. Direct aortic cannulation was achieved in 1325 (83 %) patients. Among patients with degenerative disease candidate for repair (n = 958), rate of mitral valve repair was 95 %. Repair techniques included annuloplasty (95 %), leafleat resection (63 %), neochordae implantation (16 %) and sliding plasty (11 %). Concomitant procedures included tricuspid valve repair (14.6 %), atrial fibrillation ablation (9.5 %) and atrial septal defect closure (3.2 %). Overall in-hospital mortality was 1.1 %. Thirty-four patients (2.1 %) had conversion to sternotomy. Incidence of stroke was 2 %. Overall survival at 10 years was 88 ± 2 %. Freedom from reoperation at 10 years was 94 ± 2 % for repair and 80 ± 6 % for replacement. Freedom from recurrent mitral regurgitation >3+ at 10 years was 90 ± 3 %.
  
  
  CONCLUSIONS
  Minimally invasive mitral valve surgery is a safe and reproducible approach associated with low mortality and morbidity, high rate of mitral valve repair and excellent late results.
authors.affiliation: Cardiothoracic department, Fondazione Toscana G. Monasterio, Via Aurelia Sud, Massa, Italy. Mattia.glauber@gmail.com.
authors.forename: Mattia
authors.initials: M
authors.lastname: Glauber
authors.affiliation: Cardiothoracic department, Fondazione Toscana G. Monasterio, Via Aurelia Sud, Massa, Italy. antoniomiceli79@alice.it.
authors.forename: Antonio
authors.initials: A
authors.lastname: Miceli
authors.affiliation: Cardiothoracic department, Fondazione Toscana G. Monasterio, Via Aurelia Sud, Massa, Italy. d.canarutto@gmail.com.
authors.forename: Daniele
authors.initials: D
authors.lastname: Canarutto
authors.affiliation: Cardiothoracic department, Fondazione Toscana G. Monasterio, Via Aurelia Sud, Massa, Italy. antoniolio@hotmail.it.
authors.forename: Antonio
authors.initials: A
authors.lastname: Lio
authors.affiliation: Cardiothoracic department, Fondazione Toscana G. Monasterio, Via Aurelia Sud, Massa, Italy. michelem@ftgm.it.
authors.forename: Michele
authors.initials: M
authors.lastname: Murzi
authors.affiliation: Cardiothoracic department, Fondazione Toscana G. Monasterio, Via Aurelia Sud, Massa, Italy. drgilmanov@hotmail.it.
authors.forename: Daniyar
authors.initials: D
authors.lastname: Gilmanov
authors.affiliation: Cardiothoracic department, Fondazione Toscana G. Monasterio, Via Aurelia Sud, Massa, Italy. ferrarini@ftgm.it.
authors.forename: Matteo
authors.initials: M
authors.lastname: Ferrarini
authors.affiliation: Cardiothoracic department, Fondazione Toscana G. Monasterio, Via Aurelia Sud, Massa, Italy. farneti@ftgm.it.
authors.forename: Pier A
authors.initials: PA
authors.lastname: Farneti
authors.affiliation: Cardiothoracic department, Fondazione Toscana G. Monasterio, Via Aurelia Sud, Massa, Italy. quaini@ftgm.it.
authors.forename: Eugenio L
authors.initials: EL
authors.lastname: Quaini
authors.affiliation: Cardiothoracic department, Fondazione Toscana G. Monasterio, Via Aurelia Sud, Massa, Italy. solinas@ftgm.it.
authors.forename: Marco
authors.initials: M
authors.lastname: Solinas
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D013908:Thoracotomy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome