Amine Mazine1, Nicola Vistarini2, Aly Ghoneim1, Jean-Sébastien Lebon3, Philippe Demers1, Hugues Jeanmart1, Michel Pellerin1, Denis Bouchard4. 1. Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada; Department of Cardiac Surgery, Montreal Heart Institute, Montreal, Québec, Canada. 2. Department of Cardiac Surgery, Montreal Heart Institute, Montreal, Québec, Canada; Department of Cardiac Surgery, Pavia University School of Medicine, Pavia, Italy. 3. Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada; Department of Anesthesiology, Montreal Heart Institute, Montreal, Québec, Canada. 4. Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada; Department of Cardiac Surgery, Montreal Heart Institute, Montreal, Québec, Canada. Electronic address: denis.bouchard@icm-mhi.org.
Abstract
BACKGROUND: Minimally invasive mitral valve surgery (MIMVS) is an established alternative to median sternotomy for mitral valve repair. However, this technique has yet to gain widespread adoption, partly because of concerns that this approach might yield lower repair rates or repairs that are less durable than those performed through a sternotomy. The purpose of this study was to report our inaugural experience with MIMVS, with a focus on mitral valve repair rate and midterm outcomes. METHODS: Between May 2006 and April 2012, minimally invasive mitral valve repair was attempted in 200 consecutive patients with degenerative mitral disease. The approach used was a 4- to 5-cm right anterolateral minithoracotomy with femorofemoral cannulation for cardiopulmonary bypass. Mean follow-up was 2.9 ± 1.8 years, and follow-up was 99% complete. RESULTS: The mitral valve was successfully repaired in all but 2 patients, yielding a repair rate of 99%. Hospital mortality occurred in 2 patients (1%). Intraoperative conversion to sternotomy was necessary in 12 patients (6%), including 1 of the 2 unsuccessful repairs. Mean cardiopulmonary bypass and aortic cross-clamp times were 130.8 ± 41.3 minutes and 104.8 ± 35.6 minutes, respectively. Median hospital stay was 5 days. The 5-year survival and freedom from reoperation were 97.9% ± 1.5% and 98.1% ± 1.3%, respectively. CONCLUSIONS: A very high repair rate can be achieved using MIMVS for the treatment of degenerative mitral regurgitation, including during the learning phase. Midterm survival and freedom from valve-related reoperation are excellent. MIMVS is a safe and effective alternative to mitral valve repair through a sternotomy.
BACKGROUND: Minimally invasive mitral valve surgery (MIMVS) is an established alternative to median sternotomy for mitral valve repair. However, this technique has yet to gain widespread adoption, partly because of concerns that this approach might yield lower repair rates or repairs that are less durable than those performed through a sternotomy. The purpose of this study was to report our inaugural experience with MIMVS, with a focus on mitral valve repair rate and midterm outcomes. METHODS: Between May 2006 and April 2012, minimally invasive mitral valve repair was attempted in 200 consecutive patients with degenerative mitral disease. The approach used was a 4- to 5-cm right anterolateral minithoracotomy with femorofemoral cannulation for cardiopulmonary bypass. Mean follow-up was 2.9 ± 1.8 years, and follow-up was 99% complete. RESULTS: The mitral valve was successfully repaired in all but 2 patients, yielding a repair rate of 99%. Hospital mortality occurred in 2 patients (1%). Intraoperative conversion to sternotomy was necessary in 12 patients (6%), including 1 of the 2 unsuccessful repairs. Mean cardiopulmonary bypass and aortic cross-clamp times were 130.8 ± 41.3 minutes and 104.8 ± 35.6 minutes, respectively. Median hospital stay was 5 days. The 5-year survival and freedom from reoperation were 97.9% ± 1.5% and 98.1% ± 1.3%, respectively. CONCLUSIONS: A very high repair rate can be achieved using MIMVS for the treatment of degenerative mitral regurgitation, including during the learning phase. Midterm survival and freedom from valve-related reoperation are excellent. MIMVS is a safe and effective alternative to mitral valve repair through a sternotomy.
Authors: Rebecca H Maier; Adetayo S Kasim; Joseph Zacharias; Luke Vale; Richard Graham; Antony Walker; Grzegorz Laskawski; Ranjit Deshpande; Andrew Goodwin; Simon Kendall; Gavin J Murphy; Vipin Zamvar; Renzo Pessotto; Clinton Lloyd; Malcolm Dalrymple-Hay; Roberto Casula; Hunaid A Vohra; Franco Ciulli; Massimo Caputo; Serban Stoica; Max Baghai; Gunaratnam Niranjan; Prakash P Punjabi; Olaf Wendler; Leanne Marsay; Cristina Fernandez-Garcia; Paul Modi; Bilal H Kirmani; Mark D Pullan; Andrew D Muir; Dimitrios Pousios; Helen C Hancock; Enoch Akowuah Journal: BMJ Open Date: 2021-04-14 Impact factor: 2.692