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Complex Minimal Invasive Mitral Valve Repair In Patients With Single Or Bi-leaflet Prolapse: Loop Versus Non-loop Reconstruction
Marie-Elisabeth Stelzmueller, Guenther Laufer, Wilfried Wisser, MD.
Medical University Vienna, Vienna, Austria.

Objective:
Minimal invasive endoscopic mitral valve repair (Mic) is known as a durable surgical technique for patients with mitral valve pathologies. There are different surgical techniques for a single leaflet or bi leaflet prolapse. The aim of this study is to investigate the perioperative and midterm-outcome of patients with Loop- (LR) versus non-Loop reconstruction (NLR) techniques. Methods: Between February 2009 and December 2019 197 patients underwent a Mic-surgery for severe mitral valve insufficiency(MI) based on a leafletprolaps (MLP) (single or bi) at our department. All patients undergoing a Mic by annuloplasty and additional LR-or NLR were included and divided in 2 groups; group1 patients with LR and group2 patients with NLR techniques were summarized. Patients with any concomitant operations (MAZE-procedure, tricuspid valve repair, ASD closure) or single ring annuloplasty were excluded. Results: In this study 197 patients were included, n=68 female (34.5%), mean age 5814years. Femoral percutaneous cannulation was used in 30.5% of the patients. In group1 n=123 patients were included, group2 n=74 patients (triangular resection n=36, quandrangular resection n=30, cleft closure n=3, commissurotomy n=3 and chordae transfer n=2). A prolapse of the posterior mitral valve leaflet was present in 96vs.62 patients, anterior leaflet prolapse in 8vs.2 patients and bi-leaflet in 19vs.10 patients in group1vs.group2, respectively (p-value=0.567). There was no significant difference in aortic cross clamp time of 1438min vs. 1335min in group1vs.group2, p-value=0.648. Neither in the overall reconstruction success was 96.7%vs.95.9% in group1vs.group2, nor in 30day-mortality 2.5%vs1.4% in group1vs.group2, respectively (p-value=0.611), nor in midterm reoperation rate a significant difference was seen. Conclusion: The overall reconstruction rate was satisfying. There are no significant difference between the LR and NLR, neither intra-or perioperative nor in terms of durability. Both techniques are feasible for Mic and should be chosen according to the mitral valve pathology and surgeons preference.


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