Evolution of Minimally Invasive Mitral Valve Repair: 30-Year Experience From a High-Volume Center

Background: Minimally invasive mitral valve repair (MVr) is a reproducible, widely adopted, and routinely performed surgical procedure. It is often performed in combination with tricuspid valve (TV) surgery. However, evidence on long-term results and their evolution over time is limited. This study evaluated whether outcomes of isolated minimally invasive MVr or minimally invasive MVr with concomitant TV surgery have improved over the last decades. Methods: All patients undergoing minimally invasive MVr between 1996 and 2023 were included and split into 5 periods depending on the year of surgery (period 1, 1996-2001; period 2, 2002-2007; period 3, 2008-2013; period 4, 2014-2019; period 5, 2020-2023). The primary study outcome was 10-year survival during different periods. A subanalysis was performed for patients undergoing concomitant TV surgery. The estimated 1- and 10-year survival in patients with concomitant TV surgery steadily improved, with the lowest survival in period 1 (1-year, 62.3%; 10-year, 8.9%) and the highest survival in period 4 (1-year, 92.5%; 10-year, 62.7%). Conclusions: Minimally invasive MVr surgery, isolated or in combination with TV surgery, is a safe and reproducible surgical approach with low complication rates, infrequent conversion to sternotomy, and excellent early and long-term survival.