Minimally invasive mitral valve repair for commissural prolapse: Safety, success, and long-term efficacy

OBJECTIVES Commissural prolapse (CP) is a rare and complex mitral valve pathology which is complicated in preoperative diagnosis and repair. This study evaluated the safety, success, and long-term efficacy of minimally invasive mitral valve repair (MIMVR) for CP compared to posterior leaflet prolapse (PMLp). METHODS Between 2001 and 2022, 34 patients with CP and 590 with PMLp underwent MIMVR at our center. Operative, perioperative, and long-term follow-up data were retrospectively collected. Surgical success was defined as freedom from conversion to valve replacement, sternotomy, and residual mitral regurgitation (MR) > grade I. Long-term efficacy included MR recurrence, reoperation, and survival. RESULTS Median age was similar (CP: 64.0 years [53.2; 69.8] vs PMLp: 62.0 years [53.0; 69.0], p = 0.783). Barlow’s disease was more frequent in PMLp (80.3% vs 32.4%, p < 0.001). Cross-clamp (127.0 min vs 105.0 min, p = 0.001) and bypass times (208.5 min vs 190.5 min, p = 0.031) were longer in CP. CP patients had longer hospital stays (10.0 days [8.0; 12.0] vs 8.0 days [7.0; 9.0], p < 0.001), but short-term outcomes, including 30-day mortality, stroke, and ECMO support, were comparable. At a median follow-up of 4.5 years (CP) and 2.4 years (PMLp, p = 0.001), rates of recurrent MR, reoperation, and survival were similar. CONCLUSIONS MIMVR for CP is safe, successful, and durable with outcomes comparable to PMLp. Despite greater technical complexity and longer operative times, this approach provides reliable results for CP.