title: Early and Late Outcomes After Minimally Invasive Mitral Valve Repair Surgery.
abstract: OBJECTIVE
  The practice of thoracoscopic assisted minimally invasive mitral valve repair surgery is less common in the United Kingdom than in Europe or the USA. The main reasons for this are concerns around increased operative risk, feasibility and durability of valve repair. The study aim was to report the early and late outcomes of minimally invasive mitral valve repair surgery at a single U.K. center.
  
  
  METHODS
  Patients undergoing isolated minimally invasive mitral valve repair between 2003 and 2013 were reviewed retrospectively. Data were obtained from a prospectively maintained institutional database, a comprehensive review of individual case notes, echocardiograms, intensive care charts, clinic letters, discharge summaries, and the authors' follow up database (based on data supplied by the UK Office for National Statistics).
  
  
  RESULTS
  A total of 190 patients (mean age 61 years; mean EuroSCORE 3.9) underwent the procedure. The mean cardiopulmonary bypass and aortic cross-clamp times were 153 and 108 min, respectively. Rates of major postoperative complications were: reoperation for bleeding 3.7%, stroke 1.6%, intra-aortic balloon pump 2.1%, and venovenous hemofiltration 2.6%. The median intensive care stay was one day, and the median hospital stay five days (21.8% of patients were discharged by day 3). The 30-day mortality was 1.1% (n = 2). Echocardiography performed at discharge or six weeks postoperatively showed less than mild mitral regurgitation (MR) in 91.3%. The median duration of follow up was 57 months. During the entire follow up period, four patients (2.1%) underwent repeat surgery for recurrent MR (between 15 months and five years). Of 188 patients discharged from hospital, nine (4.8%) died during follow up: median 5.3 years (range 1.3- 10.7 years) post surgery.
  
  
  CONCLUSIONS
  These data are the first from the U.K. demonstrating early and late outcomes after thoracoscopic assisted minimally invasive mitral valve repair surgery. The data establish the safety and efficacy of the technique and, importantly, lend further support towards a prospective randomized comparison of minimally invasive versus conventional mitral valve repair surgery.
authors.forename: Enoch
authors.initials: E
authors.lastname: Akowuah
authors.forename: Clare
authors.initials: C
authors.lastname: Burdett
authors.forename: Khalid
authors.initials: K
authors.lastname: Khan
authors.forename: Andrew
authors.initials: A
authors.lastname: Goodwin
authors.forename: Ignacio Bibiloni
authors.initials: IB
authors.lastname: Lage
authors.forename: Mohamed
authors.initials: M
authors.lastname: El-Saegh
authors.forename: Tracey
authors.initials: T
authors.lastname: Smailes
authors.forename: Steven
authors.initials: S
authors.lastname: Hunter
mesh_terms: D000368:Aged; D002983:Clinical Competence; D016208:Databases, Factual; D018572:Disease-Free Survival; D004739:England; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D059032:Learning Curve; D007902:Length of Stay; D008297:Male; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects / Q000401:mortality; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome