May 23, 2009European Journal of Cardio-Thoracic Surgery131 citations
Comparison of outcomes of minimally invasive mitral valve surgery for posterior, anterior and bileaflet prolapse☆
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Key Result
Minimally invasive mitral valve surgery yielded 87.3% 5-year survival and 95.6% freedom from reoperation, with no significant differences between anterior, posterior, or bileaflet prolapse.
Study Design
Type
Cohort (n=1,230)
Structured PICO
Does minimally invasive mitral valve surgery yield comparable long-term survival and freedom from reoperation in patients with anterior, posterior, or bileaflet mitral valve prolapse?
P
Population
1,230 patients (mean age 58.9 years, 32% female) with isolated anterior, posterior, or bileaflet mitral valve prolapse undergoing minimally invasive mitral valve surgery, followed for a mean of 2.7 years.
E
Exposure
Minimally invasive mitral valve surgery for anterior (AML) or bileaflet (BL) prolapse
C
Comparator
Minimally invasive mitral valve surgery for posterior (PML) prolapse
O
Outcome
Long-term survival and freedom from cardiac reoperationhard clinical
Minimally invasive mitral valve repair yields excellent long-term survival and freedom from reoperation, with comparable outcomes across anterior, posterior, and bileaflet prolapse.
Abstract
OBJECTIVE: We sought to compare the outcomes of minimally invasive mitral valve (MV) surgery for anterior (anterior mitral leaflet, AML), posterior (posterior mitral leaflet, PML) or bileaflet (BL) MV prolapse. METHODS: Between August 1999 and December 2007, 1230 patients who presented with isolated AML (n=156, 12.7%), isolated PML (n=672, 54.6%) or BL (n=402, 32.7%) MV prolapse underwent minimally invasive MV surgery. The preoperative mitral regurgitation (MR) grade was 3.3+/-0.8, left ventricular ejection fraction (LVEF) was 62+/-12% and mean age was 58.9+/-13.0 years; 836 patients (68.0%) were male. Mean follow-up time was 2.7+/-2.1 years, and the follow-up was 100% complete. RESULTS: Overall, the MV repair rate was 94.0% (1156 patients). Seventy-four patients (6.0%) received MV replacement. MV repair for PML prolapse was accomplished in 651 patients (96.9%), for AML in 142 patients (91%) and for BL in 363 patients (90.3%). Repair techniques consisted predominantly of leaflet resection and/or implantation of neochordae, combined with ring annuloplasty. Concomitant procedures were tricuspid valve surgery (n=56), atrial fibrillation ablation (n=286) and closure of an atrial septal defect or patent foramen ovale (PFO) (n=89). The overall duration of cardiopulmonary bypass was 127+/-40 min and aortic cross-clamp time was 78+/-33 min. The mean postoperative hospital stay was 11.6+/-9.7 days for the overall group. Early echocardiographic follow-up revealed excellent valve function in the vast majority of patients, regardless of the repair technique, with a mean MR grade of 0.3+/-0.5. For the overall group, 5-year survival rate was 87.3% (95% CI: 83.9-90.1) and 5-year freedom from cardiac reoperation rate was 95.6% (95% CI: 94.1-96.7). The log-rank test revealed no significant difference between the three groups regarding long-term survival or freedom from reoperation. CONCLUSIONS: Minimally invasive MV repair can be achieved with excellent results. Long-term outcomes and reoperation rates for AML prolapse are not significantly different from PML or BL prolapse.