Outcomes of minimally invasive mitral valve surgery through a right lateral mini-thoracotomy

Introduction: Our aim was to examine the outcomes of video assisted minimally invasive mitral valve surgery (MIMVS). Methods: Retrospective database review of all patients undergoing MIMVS through a right lateral mini-thoracotomy between January 1 st 2009 and Mai 31 st 2011. Results: MIMVS was performed in 181 consecutive patients. Mean age was 61 years (±12.4), median Euroscore 4.2 (1–12). Mean duration of operation was 3.5hours (±1.1), CPB time 150.3minutes (±44.4), cross clamp time 94.5minutes (±27.8). In 166 patients (91.7%) the valve was reconstructed (164 ring implantations, 103 neochordae implantations, 33 leaflet resections). In 15 (8.3%) patients the valve was replaced. 43 patients (23.7%) underwent additional atrial ablation and pulmonary vein isolation, 7 (3.9%) tricuspid valve repair, 16 (8.8%) closure of a patent foramen. Six patients (3.3%) had to be converted to sternotomy (3 pulmonary vein injury, 1 valve not accessible, 1 additional aortic valve regurgitation, 1 pleural adhesions). Mean ventilation time was 15.5 hours (0–239), ICU stay 3.1 days (0–96), hospital stay 9.8 days (3–56). 30-day mortality was 0.5% (n=1). Four patients had a neurological impairement which resolved during hospital stay (2.2%). Two were treated with inguinal wound infection. Seven patients had to be re-operated (2 on the day of operation due to SAM or circumflex artery occlusion, 1 on the third day with severe tricuspid regurgitation, 4 with recurrent mitral regurgitation on day 7, after 2, 3 and 9 months). 46 patients were followed up for up to 21 months (mean follow-up time: 10.5 months) with a MACCE-free survival of 100%. All repaired valves were competent (n=42). Conclusion: MIMVS is a safe and durable approach with a high rate of successfull and durable repair rate for all valve pathologies (91.7%).