Degenerative Mitral Valve Disease: Does Minimally-Invasive Surgery Have An Impact On Early and Mid- Term Results?
Maria Ascaso Arbona1, Alvaro Barranco2, Elena Sandoval1, Eduard Quintana1, Clemente Barriuso1, Jose Luis Pomar1, Manel Castella1, Daniel Pereda1.
1Hospital Clínic Barcelona, Barcelona, Spain, 2Universitat de Barcelona, Barcelona, Spain.
OBJECTIVE: Surgical repair remains the standard treatment for severe primary MR. Our objectives were to compare the results of mitral repair for degenerative disease and to analyze repair durability, depending on the approach used: minimally-invasive (MI) or full sternotomy. METHODS: Retrospective review of a prospectively-maintained database of all patients treated with severe degenerative MR (January 2012-February 2018). Two groups were compared: MI repair (mini-thoracotomy) and sternotomy. Patients requiring concomitant procedures other than atrial fibrillation ablation were excluded. Statistical comparisons between groups were performed using Fisher’s exact test or Wilcoxon-Mann-Whitney test as appropriate. Follow-up data were analyzed using the Log-Rank test. RESULTS: 189 consecutive patients with severe degenerative MR were treated (MI:119 patients, sternotomy:70). There were no significant differences preoperatively, except for a lower age (60.5vs.65y;p=0.005) and EuroSCORE II (0.99vs.1.42%;p=0.005) in the MI group. In both groups >30% of patients presented with anterior/bileaflet prolapse, with more frequent use of neochordae in the sternotomy group (36vs.57%;p=0.004). Bypass and cross-clamp times were significantly higher in the MI group (124vs.90.5min and 90vs.70.5min;p<0.001). The MI group showed a shorter median duration of mechanical ventilation (0vs.6h;p<0.001) and hospital stay (7vs.9days;p=0.03), with a higher hemoglobin level 5 days after surgery (11vs.10.2mg/dL;p=0.002). There were no differences in mortality (0.8vs.1.4%), repair rate (1.7vs.2.8%) or MR≤mild at discharge (98vs.96%). At 40 months, freedom from severe MR on follow-up was >90% in both groups and freedom from reoperation was 100% in the MI vs. 95.6% in the open group (p=0.055). CONCLUSIONS: Despite longer operative times, MI mitral valve repair does not compromise repair rate or perioperative outcomes. Mitral repair of degenerative MR is possible in most cases with excellent short-term results and low perioperative morbimortality. MI repair is associated with less mechanical ventilation and hospital stay and higher postoperative hemoglobin levels. MI repair is stable providing excellent mid-term echocardiographic results
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