Key result
Nonresection mitral valve repair techniques were noninferior to leaflet resection for freedom from recurrent regurgitation (overall 4-year actuarial freedom 92%; P=0.46).
Why the study?
The authors sought to analyze early and follow-up outcomes of minimally invasive video-assisted mitral valve repair, stratifying results by lesion type, repair strategy, and surgical technique.
Does minimally invasive video-assisted mitral valve repair using nonresection or totally endoscopic techniques prevent recurrent mitral regurgitation in patients with severe mitral regurgitation?
Cohort (n=241)
Does minimally invasive video-assisted mitral valve repair using nonresection or totally endoscopic techniques prevent recurrent mitral regurgitation in patients with severe mitral regurgitation?
p-value: p=0.46
Minimally invasive video-assisted mitral valve repair demonstrates optimal durability, with nonresection techniques performing similarly to traditional leaflet resection approaches.
May support minithoracotomy repair feasibility in degenerative MR; leaves open need for randomized durability data versus sternotomy.
AIMS: We sought to analyze the early and follow-up results of minimally invasive video-assisted mitral valve repair. With particular focus on degenerative disease, results were stratified according to type of lesion, strategy of repair and surgical technique. METHODS: We retrospectively built a database over 241 patients who received mitral repair for severe regurgitation through right minithoracotomy in the 2009-17 period. Cause was degenerative in 92.1%, restrictive in 5.8% and mixed in the remainders. Clinical and echocardiographic follow-up (98.7% complete, average duration 2.9 years ± 1.4) was obtained through contact of in-house and territorial cardiologists. Recurrent mitral regurgitation at follow-up was defined as being at least mild-to-moderate (2+). RESULTS: Operative mortality was 1.7%, and related to the technique in one case. Five-year actuarial survival was 95% ± 2; there was no valve-related death and one reoperation. At follow-up, we observed eight cases of 2+ regurgitation and one instance of 4+ regurgitation (4-year actuarial freedom: 92% ± 4). Freedom from recurrent regurgitation was significantly lower in the 'restrictive' subgroup vs. the 'degenerative' subgroup (P = 0.02); no statistically significant difference in freedom from recurrence was observed among patients who received mitral repair using a 'resect' vs. 'nonresection' strategy (P = 0.46), and in those who received the Totally Endoscopic technique (endoaortic balloon occlusion, no costal spreading) vs. controls (external aortic clamp, costal spreading) (P = 0.98). CONCLUSION: Durability of minimally invasive mitral repair is optimal. Nonresection repair techniques are at least noninferior to previous approaches based on leaflet resection.
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Agnino et al. (2018) conducted a cohort in Severe mitral regurgitation (n=241). Nonresection mitral valve repair vs. Leaflet resection was evaluated on Freedom from recurrent mitral regurgitation (p=0.46). Nonresection mitral valve repair techniques were noninferior to leaflet resection for freedom from recurrent regurgitation (overall 4-year actuarial freedom 92%; P=0.46).
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