Minimally Invasive MVR With Degenerative Mitral Regurgitation
Minimally Invasive MVR With Degenerative Mitral Regurgitation
Baseline characteristics are listed in Table 1. The mean age was 62±13 years, 295 (42%) patients were female and 16 (2.3%) had previous cardiac operations.
MV repair was successfully performed in 670 patients, with a rate of success of 95.3%. Repair techniques included annuloplasty (n=632), either alone (n=196) or associated with other repair techniques (n=436), including leaflet resection (n=381), neochordae implantation (n=84), and sliding plasty (n=74).
The mean CPB and cross-clamp times were 137±43 minutes and 94±37 minutes respectively. Concomitant procedures included tricuspid valve repair (n=77, 11%), atrial fibrillation ablation (n=70, 10%) and atrial septal repair (n=24, 3.4%). In one case, mitral repair was combined with an aortic valve replacement.
Direct aortic cannulation was achieved in 610 (86.8%) patients, whereas the endoaortic ballon was used in 62 patients (8.8%). Finally, 6 (1%) operations were performed in beating heart/ventricular fibrillation, as shown in Table 2.
Overall in-hospital mortality was 0.1% with a predicted median EuroSCORE of 5% (IQR 2–14.3%) (n=1: this patient died for multi-organ failure due to sepsis). Thirteen patients (1.8%) had conversion to full sternotomy because of bleeding (n=10, 1.4%) or for strong pleural adhesions (n=3, 0.5%). Reoperation for bleeding was 4.4% (n=31) whereas incidence of stroke and acute renal failure requiring dialysis were 1.3% (n=9) and 1% (n=6), respectively. Median ventilation time, ICU stay and ward stay were seven hours (IQR 5–10 hours), one day (IQR 1–1 day), and six days (IQR 5–8). Sixty-nine percent (n=488) of patients was discharged home, as shown in Table 3. After repair, residual MR at discharge was very low: no MR: (n=506, 71.8%), trivial: (n=140, 19.9%), mild: (n=24, 3.4%), moderate or severe MR: (n=1, 0.1%).
Overall one, five and eight-year survival after MV surgery was 99.3%, 93.6%, and 90.1% respectively, as shown in Figure 2. Moreover, one-, five-, and eight-year freedom from reoperation was 96%, 94%, and 93%, respectively, as shown in Figure 3. Finally, freedom from recurrent mitral regurgitation was 99% at one year, 93% at five years and 90% at eight years, shown in Figure 4.
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Figure 2.
Overall survival.
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Figure 3.
Freedom from reoperation.
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Figure 4.
Freedom from recurrent mitral regurgitation.
Results
Baseline characteristics are listed in Table 1. The mean age was 62±13 years, 295 (42%) patients were female and 16 (2.3%) had previous cardiac operations.
MV repair was successfully performed in 670 patients, with a rate of success of 95.3%. Repair techniques included annuloplasty (n=632), either alone (n=196) or associated with other repair techniques (n=436), including leaflet resection (n=381), neochordae implantation (n=84), and sliding plasty (n=74).
The mean CPB and cross-clamp times were 137±43 minutes and 94±37 minutes respectively. Concomitant procedures included tricuspid valve repair (n=77, 11%), atrial fibrillation ablation (n=70, 10%) and atrial septal repair (n=24, 3.4%). In one case, mitral repair was combined with an aortic valve replacement.
Direct aortic cannulation was achieved in 610 (86.8%) patients, whereas the endoaortic ballon was used in 62 patients (8.8%). Finally, 6 (1%) operations were performed in beating heart/ventricular fibrillation, as shown in Table 2.
Perioperative Outcomes
Overall in-hospital mortality was 0.1% with a predicted median EuroSCORE of 5% (IQR 2–14.3%) (n=1: this patient died for multi-organ failure due to sepsis). Thirteen patients (1.8%) had conversion to full sternotomy because of bleeding (n=10, 1.4%) or for strong pleural adhesions (n=3, 0.5%). Reoperation for bleeding was 4.4% (n=31) whereas incidence of stroke and acute renal failure requiring dialysis were 1.3% (n=9) and 1% (n=6), respectively. Median ventilation time, ICU stay and ward stay were seven hours (IQR 5–10 hours), one day (IQR 1–1 day), and six days (IQR 5–8). Sixty-nine percent (n=488) of patients was discharged home, as shown in Table 3. After repair, residual MR at discharge was very low: no MR: (n=506, 71.8%), trivial: (n=140, 19.9%), mild: (n=24, 3.4%), moderate or severe MR: (n=1, 0.1%).
Survival, Freedom From Reoperation and Residual MR at Follow-up
Overall one, five and eight-year survival after MV surgery was 99.3%, 93.6%, and 90.1% respectively, as shown in Figure 2. Moreover, one-, five-, and eight-year freedom from reoperation was 96%, 94%, and 93%, respectively, as shown in Figure 3. Finally, freedom from recurrent mitral regurgitation was 99% at one year, 93% at five years and 90% at eight years, shown in Figure 4.
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Figure 2.
Overall survival.
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Figure 3.
Freedom from reoperation.
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Figure 4.
Freedom from recurrent mitral regurgitation.
