Minimally invasive mitral valve surgery in octogenarians-a brief report.

The prevalence of mitral valve (MV) disease is increasing, as is the interest in modern minimally invasive MV surgery (1,2). In concordance, the age of patients being referred for MV surgery is also increasing. This growing population of elderly patients deserves special consideration due to the inherent increased surgical risk with the presence of mostly significant co-morbidities (3). The operative mortality for octogenarians who undergo MV surgery has been reported to be as high as 25% with poor long-term outcomes (3). Quality of life of octogenarians after MV surgery has been described as suboptimal and it is strongly related to the patients’ preoperative condition (4). Especially in the era of increasing interest in transcatheter MV therapies, such as percutaneous edge-to-edge repair, the surgical community currently faces another challenge to offer a valuable, effective and safe treatment option for these “fragile” patients, one with a low operative risk and a virtually life-long durability (5-7). Thus in the past, major efforts have been undertaken to minimize surgical trauma and operative risk. The minimally invasive operative approach was introduced around 15 years ago and has become the standard of care in many European and North American centres (8,9). Due to its less invasive nature, the minimally invasive approach in its current form can be anticipated to be especially valuable and suitable for these elderly and mostly fragile patients. Our centre has gained increasing experience in minimally invasive MV surgery with a total of over 4,000 operations to date. Amongst these, a significant number of octogenarians have been operated on. We herein briefly present our single centre experience within the cohort of octogenarians who underwent minimally invasive MV surgery.