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Original Articles: Adult Cardiac

A Decade of Minimally Invasive Mitral Repair: Long-Term Outcomes

Department of Cardiothoracic Surgery, New York University Medical Center, New York, New York

Accepted for publication May 8, 2009.

^_* Address correspondence to Dr Grossi, New York University Medical Center, 530 First Ave, Skirball Institute Suite 9V, New York, NY 10016 (Email: grossi{at}cv.med.nyu.edu).

Presented at the Forty-fifth Annual Meeting of The Society of Thoracic Surgeons, San Francisco, CA, Jan 26–28, 2009.

Background: Short-term results with minimally invasive approaches for mitral valve repair in degenerative disease have been encouraging, with potential for diminishing blood loss and hospital length of stay. Little is known, however, about the long-term efficacy of this approach. This report analyzes a single institution's results over 12 years with minimally invasive mitral repair.

Methods: Since 1986, 3,057 patients have undergone mitral valve repair; 1,601 patients had degenerative disease and are the subject of this report. Minimally invasive mitral repair was done in 1071 patients with a right anterior minithoracotomy and direct vision. Clinical and echocardiographic variables were entered prospectively into a database.

Results: Hospital mortality was 2.2% for all patients (36 of 1601); 1.3% for isolated minimally invasive (9 of 712) and 1.3% (3 of 223) for isolated sternotomy mitral valve repair; and 3.6% (24 of 666) for valve repair plus a concomitant cardiac procedure. For isolated valve repair, 8-year freedom from reoperation was 91% ± 2% for sternotomy and 95% ± 1% for minimally invasive (p = 0.24), and 8-year freedom from reoperation or severe recurrent insufficiency was 90% ± 2% for sternotomy and 93% ± 1% for minimally invasive (p = 0.30). Eight-year freedom from all valve-related complications was 86% ± 3% for sternotomy and 90% ± 2% for minimally invasive (p = 0.14).

Conclusions: These data indicate that long-term outcomes after minimally invasive mitral repair are excellent and equivalent to results achieved with sternotomy. In view of previously published advantages of short-term morbidity, minimally invasive approaches to mitral valve surgery deserve expanded use.

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