Twenty years’ experience with minimally invasive aortic valve repair

OBJECTIVES Aortic valve repair has become the preferred strategy to treat patients with significant aortic valve incompetence at experienced centers. Minimally invasive aortic valve repair (MIAVr) has not yet been widely adopted due to its higher technical complexity, thus we aim to present our long-term results. METHODS From 2000 to 2022, 308 patients with a median age of 56 (20–83) years (25.9% female) received MIAVr through upper ministernotomy. Follow-up data were evaluated using Kaplan–Meier and competing risk analysis. RESULTS Conversion to sternotomy was required in 3 patients (1%) and 1 patient (0.3%) suffered a perioperative stroke. Thirty-day mortality was 0.3%. During follow-up 29 patients required aortic valve reoperation. The cumulative incidence of reoperation was estimated at 4.1% (95% CI, 2.4%–7.2%) at 5 years, 11.7% (95% CI, 8.3%–16.3%) at 10 years, and 15.8% (95% CI, 11.5%–21.4%) at 15 years. The overall estimated cumulative incidence of recurrent AR ≥ moderate was 12.1% (95% CI, 9.2%–16.0%) at 5 years, 18.7% (95% CI, 15.0%–23.2%) at 10 years, and 23.0% (95% CI, 18.8%–28.1%) at 15 years. The estimated overall survival was 90.7% (95% CI, 87.2%–94.2%) at 5 years, 79.3% (95% CI, 73.8%–85.1%) at 10 years, and 63.4% (95% CI, 53.9%–74.7%) at 15 years. CONCLUSIONS MIAVr is safe and reproducible with very good long-term valve performance. Minimally invasive access does not compromise long-term durability and valve performance after aortic valve repair.