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J Thorac Cardiovasc Surg 2009;137:70-75
© 2009 The American Association for Thoracic Surgery

Acquired Cardiovascular Disease

Early and late outcomes in minimally invasive mitral valve repair: An eleven-year experience in 707 patients

^a Brigham and Women's Hospital, Division of Cardiac Surgery, Boston, Mass
^b Harvard School of Public Health, Department of Epidemiology, Boston, Mass

Received for publication June 24, 2008; revisions received August 21, 2008; accepted for publication August 27, 2008.

^_* Address for reprints: Lawrence H. Cohn, MD, Brigham and Women's Hospital, 75 Francis Street, Boston MA, 02115. (Email: lcohn{at}partners.org).

Objective: This study analyzes a single institution experience with minimally invasive mitral valve repair and evaluates long-term surgical outcomes of morbidity, mortality, and rates of reoperation. Late follow-up of mitral regurgitation and left ventricular function were also assessed.

Methods: Between August 1996 and October 2007, minimally invasive mitral valve repair was performed in 713 patients (mean follow-up 5.7 years). Excluding 6 repairs with robotic assistance, an perspective analysis of the remaining 707 patients was carried forth. Mean age was 57 ± 13 years. Mean preoperative ejection fraction was 60% ± 10%. Surgical access was through a lower ministernotomy (74%), right parasternal incision (24%), right thoracotomy (1.4%), or upper ministernotomy (0.7%). Exposure of the mitral valve was through the left atrium in 58% of the cases and transeptal in 42%. A ring annuloplasty was incorporated into 680 (96%) of 707 repairs. The Kaplan–Meier and Student t test for paired samples were used for statistical analysis.

Results: There were 3 (0.4%) operative deaths. Perioperative morbidity included new-onset atrial fibrillation (20%), reoperation for bleeding (2%), stroke (1.9%), permanent pacemaker implantation (1.7%), deep sternal wound infection (0.7%), and aortic dissection (0.4%). Median hospital stay was 5 days. Only 31% of patients required blood transfusion during the hospital course. There were 49 (6.9%) late deaths and 34 (4.8%) failed repairs necessitating reoperation. At 11.2 years, survival was 83% (95% confidence intervals, 76.5–88.1); freedom from reoperation was 92% (95% confidence intervals, 86.2–94.9). Nine (1.3%) patients were lost to follow-up. A total of 2369 patient-years of echocardiography time were obtained in 544 patients (mean 4.36 years, range 0.47–11.09). Mean grade of mitral regurgitation decreased from 3.80 to 1.42 (P < .0001) Mean left ventricular ejection fraction decreased from 60.7% to 56.3% (P < .0001). Combined risk of death, reoperation, and recurrence of moderately severe to severe mitral regurgitation was 7.7% (43/555).

Conclusion: Minimally invasive mitral valve repair is safe, with low perioperative morbidity, low rates of recurrent mitral regurgitation, and low rates of reoperation and death at late follow-up.

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